产前单疗程应用地塞米松对早产儿死亡率及围产期主要并发症的影响

Effect of Single Course of Prenatal Treatment with Dexamethasone on Mortality and Major Perinatal Morbidity in Premature Infants

目的探讨早产孕妇产前单疗程应用地塞米松对早产儿死亡率及围产期主要并发症的影响。方法选取在妇产科分娩、胎龄为28～36^(+6)周的单胎早产儿100例,按早产孕妇产前是否单疗程应用地塞米松干预分为2组:治疗组52例,早产孕妇产前给予地塞米松6mg肌内注射,q12h,连续用药4次为一疗程;对照组48例,早产孕妇产前未应用地塞米松。比较2组早产儿出院前的死亡率、围产期主要并发症[呼吸窘迫综合征(RDS)、脑室内出血(IVH)、败血症、坏死性小肠结肠炎(NEC)及孕产妇绒毛膜羊膜炎]的发生率。比较2组不同胎龄早产儿(28～32周、32^(+1)～34周、34^(+1)～36周、36^(+1)～36^(+6)周)出生后1min和5min Apgar评分。结果治疗组早产儿的死亡率和RDS的发生率均明显低于对照组(均P<0.05)。2组其他主要并发症NEC、IVH、败血症及孕产妇绒毛膜羊膜炎比较差异均无统计学意义(均P>0.05)。治疗组胎龄不足34周早产儿出生后1min和5min Apgar评分均明显高于对照组(均P<0.05),2组胎龄大于34周早产儿出生后1min和5min Apgar评分比较差异均无统计学意义(均P>0.05)。结论产前单疗程应用地塞米松可一定程度上改善早产儿的早期预后,对于胎龄小于34周并可能先兆早产的孕妇产前应积极给予地塞米松治疗。

Objective To investigate the effect of single course of prenatal treatment with dexamethasone on mortality andmajor perinatal morbidity in premature infants.Methods A total of 100 singleton preterm infants(gestational age 28-36 +6 weeks)were divided into two groups.In the treatment group(52 infants),pregnant women were antenatally given intramuscular injection of 6 mg dexamethasone once every 12 hours,4 times in a raw.The control group(48 infants)did not receive dexamethasone treatment.The mortality rate before discharge and the incidence of major perinatal complications(respiratory distress syndrome(RDS),intraventricular hemorrhage(IVH),necrotizing enterocolitis(NEC),septicemia and maternal chorioamnionitis)were recorded in both groups.In addition,postnatal 1-minute and 5-minute Apgar scores in infants of different gestational ages((28-32),(32^+1-34),(34^+1-36)and(36^+1-36^+6)weeks)were compared between the two groups.Results The mortality and incidence of RDS in treatment group were lower than those in control group(P<0.05).There were no significant differences in NEC,IVH and septicemia and maternal chorioamnionitis between the two groups(P>0.05).The postnatal 1-minute and 5-minute in infants of gestational age<34 weeks in treatment group were higher than those in control group(P<0.05).No significant differences in the Apgar scoresin infants of gestational age>34 weeks between the two groups(P>0.05).Conclusion The single course of prenatal application of dexamethasone can improve the prognosis of premature infants.Pregnant women with<34 weeks’gestational age and possible preterm labor should be actively treated with dexamethasone.