晚期早产与早期足月双胎儿围生期情况差异的临床研究

Perinatal conditions of late preterm twins versus early term twins

目的探讨晚期早产双胎新生儿(LPT)及早期足月双胎新生儿(ETT)围生期常见临床合并症情况。方法回顾性分析246例LPT及496例ETT孕母及新生儿期合并症情况,分析比较LPT发生的独立危险因素,并按胎龄分为34~34^(+6)周组(n=44)、35~35^(+6)周组(n=70)、36~36^(+6)周组(n=132)、37~37^(+6)周组(n=390)、38~38^(+6)周组(n=106),比较各组新生儿围生期合并症情况。结果孕母妊娠高血压、孕母血小板减少、前置胎盘和胎膜早破为LPT发生的独立危险因素(P<0.05)。LPT组呼吸系统疾病、喂养不耐受、低血糖症等发生率均高于ETT组(P<0.05)。34~34^(+6)周组新生儿窒息发生率高于37~37^(+6)周组、38~38^(+6)周组,败血症发生率高于36~36^(+6)周组(P<0.0045);34~34^(+6)周组、35~35^(+6)周组新生儿呼吸窘迫综合征、新生儿呼吸暂停、新生儿贫血发生率均高于其他3组,新生儿肺炎、低血糖症、败血症发生率高于37~37^(+6)周组、38~38^(+6)周组(P<0.0045);35~35^(+6)周组喂养不耐受发生率高于36~36^(+6)周组、37~37^(+6)周组、38~38^(+6)周组(P<0.0045);36~36^(+6)周组低血糖症发生率低于34~34^(+6)周组,高于37~37^(+6)周组(P<0.0045)。结论相比于ETT,LPT围生期合并症发生率较高;不同胎龄LPT及ETT围生期合并症不同,应重视对不同胎龄双胎儿的个体化监测及合理治疗。

Objective To study the perinatal complications of late preterm twins(LPTs)versus early term twins(ETTs).Methods A retrospective analysis was performed for the complications of 246 LPTs,496 ETTs,and their mothers.The risk factors for late preterm birth were analyzed.According to gestational age,the twins were divided into five groups:34-34^(+6) weeks(n=44),35-35^(+6) weeks(n=70),36-36^(+6) weeks(n=132),37-37^(+6) weeks(n=390),and 38-38^(+6) weeks(n=106).The perinatal complications were compared between groups.Results Maternal hypertension,maternal thrombocytopenia,placenta previa,and premature rupture of membranes were independent risk factors for late preterm birth in twins(P<0.05).The LPT group had higher incidence rates of respiratory diseases,feeding intolerance,and hypoglycemia than the ETT group(P<0.05).The 34-34^(+6) weeks group had a higher incidence rate of neonatal asphyxia than the 37-37^(+6) weeks and 38-38^(+6) weeks groups;and had a higher incidence rate of septicemia than 36-36^(+6) weeks group(P<0.0045).The 34-34^(+6) weeks and 35-35^(+6) weeks groups had higher incidence rates of neonatal respiratory distress syndrome,neonatal apnea,and anemia than the other three groups;and had higher incidence rates of neonatal pneumonia,hypoglycemia and septicemia than the 37-37^(+6) weeks and 38-38^(+6) weeks groups(P<0.0045).The 35-35^(+6) weeks group had a higher incidence rate of feeding intolerance than the 36-36^(+6) weeks,37-37^(+6) weeks,and 38-38^(+6) weeks groups(P<0.0045).The 36-36^(+6) weeks group had a lower incidence rate of hypoglycemia than the 34-34^(+6) weeks group and a higher incidence rate of hypoglycemia than the 37-37^(+6) weeks group(P<0.0045).Conclusions Compared with ETTs,LPTs have an increased incidence of perinatal complications.The incidence of perinatal complications is associated with gestational ages in the LPTs and ETTs.