未足月胎膜早破致不良新生儿结局的高危因素分析和护理对策

Analysis of risk factors and nursing countermeasures of adverse neonatal outcomes caused by preterm premature rupture of membranes

目的分析未足月胎膜早破(PPROM)致不良新生儿结局的高危因素,总结护理应对策略。方法选取2018年2月至2020年2月信宜市妇幼保健院妇产科收治的300例PPROM初产妇纳入观察组,同时选取同期收治的正常初产妇200名纳入对照组。对比两组产妇和新生儿基本资料,收集病史和临床信息,将以上纳入因素进行单因素与多因素Logistic回归分析,确定PPROM患者不良新生儿结局高危因素。结果多因素非条件Logistic回归分析显示,孕前体质指数≥25 kg/m^(2)(OR=1.772)、胎位异常(臀位/头盆不对称,OR=3.951)、腹压升高(OR=1.976)、血小板计数与淋巴细胞计数比值(PLR)过高(OR=4.889)、组织学绒毛膜羊膜炎(HCA,OR=3.777)等均为导致PPROM致不良新生儿结局独立危险因素。结论发生PPROM后孕妇风险较高,严重影响妊娠和分娩结局。故针对孕前超重、胎位异常、腹压升高、PLR过高、HCA等高危因素,护理人员要高度重视,避免或消除高危因素,降低其发生概率,以改善母婴结局。

Objective To analyze the risk factors of adverse neonatal outcomes caused by preterm premature rupture of membranes(PPROM)and summarize the nursing countermeasures.Methods 300 cases of primiparae with PPROM who were admitted to the Department of Obstetrics and Gynecology at Xinyi Maternal and Child Health Hospital from February 2018 to February 2020 were selected into the observation group,and 200 cases of normal primiparae admitted during the same period were selected into the control group.The basic data of primiparae and newborns were compared between the two groups,and the medical history and clinical information were collected.The univariate and multivariate logistic regression of the above included factors were performed to determine the risk factors of adverse neonatal outcomes in primiparae with PPROM.Results Multivariate unconditional logistic regression analysis showed pre-pregnancy body mass index≥25 kg/m^(2)(OR=1.772),abnormal fetal position(breech position/cephalopelvic disproportion)(OR=3.951),increased abdominal pressure(OR=1.976),exorbitant platelet to lymphocyte ratio(PLR)(OR=4.889),histological chorioamnionitis(HCA)(OR=3.777)were all independent risk factors of adverse neonatal outcomes in PPROM.Conclusion The risk of PPROM in pregnant women is high,which seriously affects the pregnancy and delivery outcomes.Therefore,nursing staff should pay great attention to risk factors such as pre-pregnancy overweight,abnormal fetal position,increased abdominal pressure,high PLR,and HCA,avoid or eliminate the risk factors,reduce the incidence of PPROM,so as to improve maternal and infant outcomes.