产程发热与宫内感染的临床分析

Clinical Analysis of Fever during Labor and Intrauterine Infection

目的探析产程发热与宫内感染的临床特点,为临床产程发热、宫内感染的鉴别工作提供参考依据。方法选取北京万柳美中宜和妇儿医院和北京市丰台区铁营医院2019年1月—2020年12月收治的产程发热产妇126例为研究对象,按是否发生宫内感染,将其分成参照组90例(未发生宫内感染)和研究组36例(发生宫内感染)。对比分析两组体质指数、胎心率、白细胞、CRP、IL-6、IL-8水平、不良妊娠结局发生率。结果研究组体质指数(BMI)、白细胞(WBC)均高于参照组;胎心率、白介素-6(IL-6)、白介素-8(IL-8)均高于参照组,差异有统计学意义(P<0.05)。多元Logistic回归分析显示:WBC、CRP曲线下面积均>0.60,其中WBC敏感度为66.67%,截点值10.16×10^(9)/L;CRP的特异度为85.71%,截点值14.11 mg/L。研究组不良妊娠结局发生率高于参照组(36.11%vs 6.67%),差异有统计学意义(χ^(2)=17.409,P<0.001)。结论产程发热产妇宫内感染的原因可能与胎膜早破、羊水粪染有关,在产妇分娩期间应对其充分关注,WBC、CRP可作为产程发热宫内感染的诊断指标,在产程发热、宫内感染的鉴别工作中具有重要指导意义。

Objective To analyze the clinical characteristics of fever during labor and intrauterine infection,and to provide a reference for the identification of fever and intrauterine infection during clinical labor.Methods 126 pregnant women with fever during labor Beijing Wanliumei Zhongyi and Women and Children Hospital and Beijing Fengtai District Tieying Hospital from January 2019 to December 2020 were selected as the research object.According to the occurrence of intrauterine infection,they were divided into a reference group of 90 cases(no introuterine infection occurred)and a study group of 36 cases(intrauterine infection).Compared and analyzed the body mass index,fetal heart rate,leukocyte,CRP,IL-6,IL-8 levels,incidence of adverse pregnancy outcomes of the two groups.Results The body mass index(BMI)and leukocyte(WBC)of the study group were higher than those of the reference group;the fetal heart rate,interleukin-6(IL-6)and interleukin-8(IL-8)were higher than those of the reference group,and the difference was statistically significant(P<0.05).Multiple Logistic regression analysis showed that the area under the WBC and CRP curves was>0.60,in which the WBC sensitivity was 66.67%and the cutoff value was 10.16×10^(9)/L;the specificity of CRP was 85.71%,and the cutoff value was 14.11 mg/L.The incidence of adverse pregnancy outcomes in the study group was higher than that in the reference group(36.11%vs 6.67%),and the difference was statistically significant(χ^(2)=17.409,P<0.001).Conclusion The cause of intrauterine infection in pregnant women with fever during labor may be related to premature rupture of membranes and fecal contamination of amniotic fluid.Full attention should be paid to them during delivery.WBC and CRP can be used as diagnostic indicators for fever during labor and intrauterine infection.It has important guiding significance in the identification of infection.