胎膜早破与<34周早产儿肺疾病及感染指标等关系的研究

ASSOCIATION OF PREMATURE RUPTURE OF MEMBRANES WITH LUNG DISEASES AND INFECTION INDICES IN PRETERM INFANTS WITH A GESTATIONAL AGE OF <34 WEEKS

目的探讨胎膜早破(PROM)与<34周早产儿肺疾病及感染指标等关系的研究。方法收集在我院产科分娩入住新生儿科的<34周早产儿234例,根据是否发生胎膜早破(PROM)分为无PROM早产儿组(52例),PROM≤48h早产儿组(84例),PROM 49~168h早产儿组(59例),PROM>168h早产儿组(39例)。收集孕妇产前相关资料及早产儿入院后相关资料,比较不同PROM时间下早产儿肺部疾病发生率及各感染指标等的差异。结果 PROM时间越长,支气管肺发育不良、肺炎的发生率越高,各组比较差异有显著性(P<0.05);PROM48h内新生儿呼吸窘迫综合征发生率最高,PROM 48h后随PROM时间延长,其发生率逐渐降低,各组比较差异有显著性(P<0.05)。PROM时间越长,早产儿血液中降钙素原水平越高,各组比较差异有显著性(P<0.05);各组血液中白细胞计数、C反应蛋白水平比较差异无显著性(P>0.05)。孕妇产前抗生素及激素使用情况、临床型HCA、羊水污染率及宫腔分泌物培养阳性率随PROM延长,其发生率逐渐增高,各组比较差异有显著性(P<0.05);各组早产儿胎龄、出生体质量、剖宫产、宫内窘迫情况比较差异均无显著性(P>0.05)。结论 PROM暴露时间越长早产儿发生肺部疾病的发生率越高,早产儿感染指标也越高。此外,随PROM时间延长,早产儿其他系统疾病的发生率也会升高。

Objective To investigate the association of premature rupture of membranes with lung diseases and infection indices in preterm infants with a gestational age （GA） of〈34 weeks. Methods A total of 234 preterm infantswith a GA of〈34 weeks who were born in Department of Obstetrics and admitted to Department of Neonatology in our hospital were enrolled,and according to the presence or absence of premature rupture of membranes（PROM）,they were divided into non-PROM group with52 infants,PROM≤48 hgroup with 84 infants,PROM 49-168 hgroup with 59 infants,and PROM〉168 hgroup with 39 infants.The data of the pregnant women before delivery and the premature after admission were collected,and the incidence rate of lung diseases and infection indices were compared between these groups. Results The incidence rates of bronchopulmonary dysplasiaand pneumonia increased significantly with the time of PROM,and there were significant differences between groups（P〈0.05）.The PROM≤48 hgroup had the highest incidence rate of neonatal respiratory distress syndrome,which then gradually decreased with the increase in the time of PROM,and there was a significant difference between groups（P〈0.05）.The level of procalcitonin in blood increased with the time of PROM,and there was a significant difference between groups（P〈0.05）.There were no significant differences in leukocyte count and C-reactive protein between groups（P〉0.05）.There were increases in the application of antibiotics and hormone before delivery,the proportion of pregnant women with clinical/histological chorioamnionitis,the rate of amniotic fluid pollution,and the positive rate of uterine secretion culture over the time of PROM,and there were significant differences between groups（P〈0.05）.There were no significant differences in GA,birth weight,cesarean section,and intrauterine distress between groups（P〉0.05）. Conclusion The incidence rate of lung diseases and infection indices increase with the time of PROM.The incidence rates of diseases involving other systems also increase with the time of PROM.