实用医学杂志 ›› 2021, Vol. 37 ›› Issue (15): 1976-1981.doi: 10.3969/j.issn.1006⁃5725.2021.15.014

• 临床研究 • 上一篇    下一篇

胎膜早破时间对<34周早产儿早期结局的影响

张素娥1, 陈春1, 陈思齐2, 林彦青1, 杨传忠1   

  1. 南方医科大学附属深圳市妇幼保健院 1 新生儿科,2 妇幼医学研究所(广东深圳 518028)

  • 出版日期:2021-08-10 发布日期:2021-08-10
  • 通讯作者: 杨传忠 E⁃mail:yangczgd@163.com
  • 基金资助:
    深圳市卫生计生系统科研项目(编号:SZXJ2017007);深圳市“医疗卫生三名工程”(编号:SZSM201612045)

Impact of latency period after premature rupture of membranes on early outcomes of preterm infants with gestational age<34 weeks

ZHANG Sue,CHEN Chun,CHEN Siqi,LIN Yanqing,YANG Chuanzhong.   

  1. Depart⁃ ment of Neonatology,Affiliated Shenzhen Maternity and Child Healthcare Hospital,Southern Medical University, Shenzhen 518028,China


  • Online:2021-08-10 Published:2021-08-10
  • Contact: YANG Chuanzhong E⁃mail:yangczgd@163.com

摘要:

目的 探讨胎膜早破时间对早产儿早期结局的影响,为未足月胎膜早破产前咨询、临床管 理提供依据。方法 收集 2016-2019 年出生胎龄<34 周的单胎未足月胎膜早破早产儿 528 例,对其早期结局进行统计分析。结果 破膜孕周<28 周时,胎膜早破时间≥ 7 d 可降低中重度支气管肺发育不良、坏死性小肠结肠炎、重症早产儿视网膜病变、脑室内出血(≥ 3 级)/脑室周围白质软化等严重并发症的总体 发病率,≥ 3 d 可降低重症早产儿视网膜病变发病率(P<0.05);破膜孕周 28 ~ 34 周时,不同胎膜早破时间 组早产儿早期结局指标间差异均无统计学意义(P>0.05)。logistic 回归分析发现,出生胎龄小是院内死 亡、早发型败血症、严重并发症的独立危险因素(OR分别为0.229、0.705、0.499,95%CI分别为0.092 ~ 0.570 0.617 ~ 0.805、0.432 ~ 0.576),临床绒毛膜羊膜炎是早发型败血症的独立危险因素(OR = 3.835,95%CI 1.797 ~ 8.181)。结论 延长胎膜早破时间可延长孕周、改善<34 周早产儿的早期结局,但需注意有无临 床绒毛膜羊膜炎发生。建议破膜孕周<28周者延长胎膜早破时间≥ 7 d。

关键词:

未足月胎膜早破, 胎膜早破时间, 结局, 早发型败血症, 早产儿

Abstract:

Objective To study the impact of latency period after preterm premature rupture of mem⁃ branes(PPROM)on early outcomes of preterm infants,and to provide reference for prenatal consultation and man⁃ agement of PPROM. Methods A total of 528 singleton preterm infants before 34 weeks′ gestation who were born after PPROM were enrolled between 2016 and 2019. Statistical analysis was performed for early outcomes of preterm infants. Results For preterm infants with PPROM before 28 weeks′ gestation,latency period after PPROM ≥ 7 d could reduce the total rate of severe morbidity,including moderate and severe bronchopulmonary dysplasia,necrotizing enterocolitis,severe retinopathy of prematurity,intraventricular hemorrhage(≥ grade 3)/ periventricular white matter;latency period ≥3 d could reduce the rate of severe retinopathy of prematurity(ROP P<0.05). No statistical difference was found in in⁃hospital mortality and rate of early⁃onset sepsis between differ⁃ ent latency period groups(P>0.05). For preterm infants with PPROM between 28~34 weeks′ gestation,no statisti⁃ cal difference was found in all the early outcomes between different latency period groups(P>0.05). Multivariate logistic regression analysis showed that a smaller gestational age at birth was an independent risk factor for in⁃hospi⁃ tal mortality,early⁃onset sepsis and severe morbidity(OR = 0.229,0.705 and 0.499 respectively,95%CI 0.092 ~ 0.570,0.617 ~ 0.805,0.432 ~ 0.576 respectively),Clinical chorioamnionitis was an independent risk factor for early ⁃onset sepsis(OR = 3.835,95%CI:1.797 ~ 8.181). Conclusion Prolonged latency period after PPROM could increase gestational age and improve the early outcomes of preterm infants with gestational age<34 weeks but attention should be paid to clinical chorioamnionitis. Prolonged latency period to ≥ 7 d was advised for PPROM before 28 weeks′ gestation .

Key words:

preterm premature rupture of membranes(PPROM), latency period, outcomes, early? onset sepsis, preterm infant ,