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目的评估不同胎龄足月儿选择性剖宫产(ECD)分娩后呼吸系统疾病的发生风险,探讨减少新生儿呼吸系统疾病发生的ECD时机。方法对2008年6月至2013年6月在郑州人民医院行ECD分娩的新生儿进行回顾性分析。入选标准:胎龄37~39周,单胎,母亲无妊娠期合并症和并发症,剖宫产前无胎膜早破及临产征象。分析胎龄37、38、39周三组新生儿的一般情况及呼吸系统疾病发生情况。结果共有1152例胎龄37~39周的ECD新生儿纳入研究,37周组136例,38周组401例,39周组615例,因发生呼吸系统疾病转入新生儿科的病例94例,其中37周组20例,呼吸系统疾病发生率14.7%;38周组38例,呼吸系统疾病发生率9.5%;39周组36例,呼吸系统疾病发生率5.8%。胎龄越大,ECD新生儿呼吸系统疾病发生率越低,差异有统计学意义(P<0.05)。胎龄37~39周ECD新生儿中,发生的呼吸系统疾病以湿肺、窒息及肺炎为主,湿肺共51例,占54.2%;窒息共9例,占9.6%;肺炎共17例,占18.1%。胎龄37周和38周进行ECD的新生儿呼吸系统疾病发生率均较胎龄39周增高(OR分别为2.5和1.8,P均<0.05)。结论胎龄37~38周进行ECD可增加新生儿呼吸系统疾病的发生率,ECD尽可能在妊娠39周后进行。
Objective To assess the risk of respiratory diseases after selective cesarean section (ECD) delivery in term infants of different gestational ages and to explore the timing of ECD to reduce neonatal respiratory diseases. Methods Retrospective analysis was performed on newborns delivered by ECD in Zhengzhou People’s Hospital from June 2008 to June 2013. Inclusion criteria: 37-39 gestational age, single-fetus, mothers without pregnancy complications and complications, premature rupture of membranes without premature ejaculation and labor signs. Analysis of gestational age 37,38,39 week group of three newborns general situation and respiratory disease. Results A total of 1152 neonates with ECD at 37-39 gestational age were enrolled in the study. One hundred and sixty-six patients were enrolled in 37-week group, 401 in 38-week group and 615 in 39-week group. Of the 94 neonates with respiratory diseases, Twenty cases were in the 37-week group and the incidence of respiratory diseases was 14.7%. 38 cases in the 38-week group had a respiratory rate of 9.5%, 36 cases in the 39-week group and 5.8% in the respiratory system. The higher the gestational age, the lower the incidence of respiratory diseases in neonates with ECD, the difference was statistically significant (P <0.05). In 37-39-week-old ECD newborns with gestational age, the most common respiratory diseases were wet lung, asphyxia and pneumonia. Fifty-one cases were wet-lung, accounting for 54.2%. Asphyxia was 9 cases (9.6%), pneumonia was 17 cases Accounting for 18.1%. The incidence of respiratory diseases in neonates with ECD at 37 and 38 weeks gestational age were significantly higher than those at 39 weeks gestation (OR 2.5 and 1.8, respectively, P <0.05). Conclusion ECD at 37-38 weeks gestational age may increase the incidence of respiratory diseases in newborns. ECD may be performed after 39 weeks gestation.