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目的探讨选择性剖宫产产前预防性应用激素对胎龄37周及以上足月儿呼吸系统近期并发症发生情况及收住新生儿重症监护病房的影响。方法选择2010年1月至2014年12月瑞安市人民医院选择性剖宫产的孕妇及其新生儿进行随机对照研究,将纳入研究的胎龄37周后的孕妇及其新生儿分别分为两组,干预组孕妇于分娩前24 h完成1个疗程地塞米松促进肺成熟,对照组予以常规护理。比较两组新生儿呼吸困难发生率及因呼吸困难收住新生儿重症监护病房的比率。结果干预组共纳入分析2 080对孕妇及新生儿,对照组共纳入分析2 144对孕妇及新生儿。两组孕妇一般情况及新生儿性别、胎龄、出生体重、Apgar评分差异均无统计学意义(P>0.05)。干预组新生儿呼吸困难发生率低于对照组(2.7%比5.5%)(P<0.05),湿肺及呼吸窘迫综合征发生率均低于对照组(2.4%比4.2%,0.3%比1.3%)(P<0.05)。糖皮质激素产生最佳效果的胎龄为37周。胎龄37周和38周进行选择性剖宫产的新生儿呼吸困难发生率均较胎龄39周增高(OR分别为9.014和3.632,P均<0.05)。结论产前应用地塞米松或延迟至妊娠39周后选择性剖宫产能减少新生儿因呼吸系统并发症收住新生儿监护病房。
Objective To investigate the effect of prenatal prophylactic cesarean section on the occurrence of short-term respiratory complications and full-term neonatal intensive care unit in gestational age of 37 weeks and older. Methods From January 2010 to December 2014, Ruian People’s Hospital, a selective cesarean section of pregnant women and their newborns were randomized controlled study will be included in the study of gestational age 37 weeks pregnant women and their newborns were divided into two In the intervention group, pregnant women completed one course of dexamethasone 24 h before delivery to promote lung maturation and the control group received routine nursing. The incidence of dyspnea in both groups was compared between the two groups and the rate of admission to the neonatal intensive care unit due to dyspnea was compared. Results The intervention group was included in the analysis of 2 080 pairs of pregnant women and newborns, control group were included in the analysis of 2 144 pairs of pregnant women and newborns. There were no significant differences in the general situation of the two groups of pregnant women and neonatal gender, gestational age, birth weight, Apgar score (P> 0.05). The incidence of neonatal respiratory distress in the intervention group was lower than that in the control group (2.7% vs. 5.5%, P <0.05), and the incidence of wet lung and respiratory distress syndrome was lower in the intervention group than in the control group (2.4% vs 4.2%, 0.3% vs 1.3 %) (P <0.05). Gestational age at which glucocorticoid produces the best effect is 37 weeks. The incidence of dyspnea in neonates with selective cesarean section at gestational weeks 37 and 38 was higher than that at gestational weeks 39 (OR = 9.014 and 3.632, respectively, P <0.05). Conclusion Prenatal dexamethasone or delayed cesarean section after 39 weeks of gestation can reduce neonatal neonatal hospital admissions due to respiratory complications.