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目的探讨在未足月胎膜早破(PPROM)患者中发生组织学绒毛膜羊膜炎(HCA)的临床特征及新生儿结局。方法 2010年1月至2015年1月湖北省妇幼保健院共收治214例PPROM患者,均为单胎妊娠且孕28~33+6周,以产后的胎盘病理为依据分为HCA组(145例)及无HCA组(69例)。比较两组的临床特征、各检测指标、新生儿结局,同时采用多因素Logistic回归分析对发生HCA的危险因素进行分析。结果与无HCA组比较,HCA组的破膜孕周显著减小,其分娩时C反应蛋白(CRP)水平、入院时羊水过少、剖宫产率均显著增高;而新生儿出生的孕周及体重显著降低,新生儿1min Apgar评分<7分、支气管肺发育不良、新生儿肺炎、早发型败血症、颅内超声异常的发生率及围产儿病死率也均显著增高,差异均有统计学意义(P<0.05)。经多因素Logistic回归分析结果显示孕妇羊水过少、破膜孕周<32周、破膜至临产的时间为48~168h、分娩时CRP水平>8mg/L是诱发HCA的危险因素(P<0.05)。结论发生HCA后能使PPROM新生儿多种疾病的发生率及新生儿病死率显著上升;而患者羊水过少、破膜孕周<32周、潜伏期48~168h、分娩时CRP水平>8mg/L均为诱发HCA的相关因素。
Objective To investigate the clinical characteristics and neonatal outcome of histological chorioamnionitis (HCA) in patients with incomplete premature rupture of membranes (PPROM). Methods From January 2010 to January 2015, Hubei Provincial Maternal and Child Health Hospital admitted a total of 214 patients with PPROM, both singleton pregnancies and 28 ~ 33 + 6 weeks of pregnancy. The postpartum placental pathology was divided into HCA group (145 cases ) And no HCA group (69 cases). The clinical characteristics, the detection indexes and the neonatal outcome of the two groups were compared. At the same time, multivariate logistic regression analysis was used to analyze the risk factors of HCA. Results Compared with the non-HCA group, the gestational weeks of the rupture of HCA group were significantly reduced, the C-reactive protein (CRP) level at delivery, oligohydramnios at admission, and cesarean section rate were significantly increased. However, gestational age at birth And body weight were significantly reduced. Apgar score <7 points at 1 minute in neonates, bronchopulmonary dysplasia, neonatal pneumonia, early-onset septicemia, the incidence of intracranial ultrasound abnormalities and perinatal mortality were also significantly increased, the differences were statistically significant (P <0.05). Multivariate logistic regression analysis showed that oligohydramnios in pregnant women was less than 32 weeks pregnant, rupture of membrane was 48 to 168 hours, and CRP level was 8 mg / L during labor (P <0.05) ). Conclusions The incidence of neonatal morbidity and neonatal mortality in PPROM increased significantly after HCA. The patients had oligohydramnios, the rupture period was 32 weeks, the incubation period was 48 to 168 hours, and the CRP level at delivery was> 8 mg / L Are related to HCA-induced factors.