预防胎膜早破孕妇B族链球菌感染的临床方案效果分析

Effectiveness of Clinical Protocol for Prevention of Group B Streptococcal Infection in Women with Premature Rupture of Membranes

目的：对2010年美国疾病预防控制中心（CDC）B族链球菌（GBS）预防指南中关于胎膜早破（PROM）孕妇的管理策略进行确认。方法：选取2016年1—2月间在苏州市立医院住院分娩的PROM孕妇394例的临床资料进行回顾性研究,其中未足月胎膜早破（PPROM组）84例（孕周〈37周）,足月胎膜早破（足月PROM组）310例（孕周≥37周）,根据2010年美国CDC指南中关于PROM孕妇的管理策略进行临床实施,同时借鉴了既往指南中基于培养和基于高危因素的2种方案给予产时抗生素预防（IAP）,追踪新生儿结局。统计2组PROM孕妇中GBS定植率,新生儿早发型GBS感染性疾病（EOD）的发生率及其相关性,同时分析了IAP对EOD发生率的影响。结果：PPROM组的GBS定植率高于足月PROM组,差异有统计学意义（11.9%vs.4.8%,χ^2=5.55,P=0.018）,PROM孕妇中GBS定植是早产的危险因素（OR=2.658,95%CI：1.148-6.155）。PPROM组与足月PROM组的EOD发生率比较差异无统计学意义（2.38%vs.0.65%,χ^2=1.98,P=0.159）。充分IAP的孕妇其新生儿无一例发生EOD（0/212）,未进行IAP或IAP不充分孕妇EOD的发生率为2.25%（4/178）,差异有统计学意义（χ^2=4.71,P=0.03）,充分IAP是EOD的保护因素（OR=0.456,95%CI：0.410-0.509）。结论：对于胎膜早破孕妇需严格遵循指南进行筛查管理及IAP,重视高危因素,其中早产是最值得关注的高危因素。

Objective： To validate and discuss the efficacy of clinical protocol for prevention of Group B streptococcal（GBS） disease in women with premature rupture of membranes （PROM） according to the guidelines of 2010 CDC. Methods： A retrospective cohort study of 394 women with PROM admitted at the Suzhou Municipal Hospital between Jan. 2016 and Feb. 2016, including 84 women with preterm premature rupture of membranes （PPROM） and 310 women with PROM in term labor. All women were managed according to the protocol for PROM in 2010 CDC guidelines, also refer to the two strategy in previous guidelines based on culture and risk factors to conduct the intrapartum antibiotic prophylaxis （IAP）. The GBS colonization rate and the incidence of early-onset group B streptococcal disease （EOD） in the two groups were compared, respectively. The effect of IAP on the incidence of EOD was also analyzed. Results： The rate of GBS colonization in the PPROM group was higher than that in the PROM group（ 11.9% vs. 4.8%,; χ^2=5.55, P=0.018）. In the PROM group, GBS colonization is a risk factor for PPROM （OR =2.658, 95%CI：1.148-6.155）. The difference of the incidence of EOD between the PPROM group and the PROM group was not significant （2.38% vs. 0.65%, χ^2=1.98, P=0.159）. There was not an infected newborn in those PROM mother with the complete IAP （0/212）, while the incidence of EOD in those women who underwent inadequate IAP or no IAP was 2.25% （4/178 ） （χ^2=4.71, P=0.03）, suggesting that the complete IAP is the protective factor for EOD （OR =0.456,95%CI： 0.410-0.509）. Conclusions： It is necessary to screen and manage those women with PROM, to conduct the IAP strictly according to the guidelines, and to notice those primary risk factors in which the premature delivery is the most notable factor.