头孢噻肟或头孢他啶联合阿奇霉素改善未足月胎膜早破孕妇母婴结局效果评价

Cefotaxime or Ceftazidime Combined with Azithromycin in Improving the Maternal and Neonatal Outcomes of Pregnant Women with Preterm Premature Rupture of Membranes

目的探讨头孢噻肟或头孢他啶联合阿奇霉素用于改善未足月胎膜早破(PPROM)孕妇母婴结局的有效性和安全性,并分析胎膜早破病原学分布特点和细菌耐药形势。方法选取医院2018年3月至2019年5月分娩的PPROM孕妇143例,随机分为观察组(72例,予头孢噻肟或头孢他啶联合阿奇霉素)和对照组(71例,予氨苄西林联合红霉素)。结果观察组潜伏期较对照组显著延长,观察组孕妇分娩前体温和降钙素原(PCT)出现异常、临床绒毛膜羊膜炎、组织学绒毛膜羊膜炎的发生率,以及采用剖宫产终止妊娠的概率均明显低于对照组(P<0.05);观察组新生儿的体质量大于对照组,观察组新生儿肺炎发生率低于对照组(P<0.05)。结论重庆地区PPROM相关病原体以大肠埃希菌和非典型病原体为主,细菌耐药形势较国外严峻,不宜照搬国外指南的推荐方案。头孢噻肟或头孢他啶联合阿奇霉素能有效改善PPROM孕妇的母婴结局,可供特殊人群安全、有效、合理使用抗菌药物提供参考。

Objective To explore the efficacy and safety of cefotaxime or ceftazidime combined with azithromycin in improving the maternal and neonatal outcomes of pregnant women with preterm premature rupture of membranes(PPROM),and analyze the etiological distribution characteristics and bacterial resistance situation of premature rupture of membranes.Methods A total of 143 cases of pregnant women with PPROM that had given birth in the hospital from March 2018 to May 2019 were selected and randomly divided into the observation group(72 cases,treated with cefotaxime or ceftazidime combined with azithromycin)and control group(71 cases,treated with ampicillin combined with erythromycin).Results The incubation period of the observation group was significantly longer than that of the control group.The incidence of abnormal body temperature and procalcitonin(PCT)before delivery in the observation group,clinical chorioamnionitis,histological chorioamnionitis and the probability of termination of pregnancy by cesarean Both were significantly lower than the control group(P<0.05);the neonatal body mass of the observation group was greater than that of the control group,and the incidence of neonatal pneumonia in the observation group was lower than that of the control group(P<0.05).Conclusion The pathogens related to PPROM in Chongqing area are mainly Escherichia coli and atypical pathogens,and the bacterial resistance situation is more serious than abroad,so it is not appropriate to copy the recommendations of foreign guidelines.Cefotaxime or ceftazidime combined with azithromycin can effectively improve the maternal and child outcomes of PPROM pregnant women,and provide a basis for the safe,effective and reasonable use of antibacterial drugs for special populations.