胎膜早破对孕母感染及早产儿结局的影响

Effect of premature rupture of membranes on maternal infections and outcome of preterm infants

摘要:

目的 探讨胎膜早破（PROM）对孕母感染及早产儿结局的影响。方法 以441例早产儿及其母亲（387例）为研究对象，根据孕母是否胎膜早破分为对照组（无PROM，104例），PROM时间< 72 h组（90例）及≥72 h组（193例）。比较各组母、婴的临床特点及并发症差异。结果 破膜时间≥72 h组孕母的年龄、脐血管炎发生率以及抗生素应用高于对照组和破膜时间< 72 h组（P < 0.05）；中-重度绒毛膜羊膜炎的发生率高于对照组（P < 0.05），但与< 72 h组的差异无统计学意义（P > 0.05）。破膜时间≥72 h组早产儿肺炎、颅内出血的发生率高于对照组和破膜时间< 72 h组（P < 0.01）；先天性感染的发生率、住院天数高于对照组（P < 0.05），但与< 72 h组的差异无统计学意义（P > 0.05）。多因素回归分析显示，破膜时间≥72 h是早产儿发生肺炎（P < 0.05）及颅内出血（P < 0.05）的独立危险因素。结论 破膜时间≥72 h使孕母胎盘炎症发生风险增加，而且与早产儿肺炎、颅内出血发生相关。

Abstract:

Objective To investigate the effect of premature rupture of membranes (PROM) on maternal infections and outcome of preterm infants.Methods A total of 441 preterm infants and 387 mothers were enrolled as subjects. According to the presence or absence of PROM, the mothers were divided into non-PROM group with 104 mothers, PROM duration < 72 hours group with 90 mothers, and PROM duration ≥72 hours group with 193 mothers. The three groups were compared in terms of clinical features of mothers and infants and complications.Results Compared with the control group and the PROM duration < 72 hours group, the PROM duration ≥72 hours group had significantly higher maternal age, incidence rate of umbilical vasculitis, and rate of antibiotic use; the PROM duration ≥72 hours group had a significantly higher incidence rate of moderate-to-severe chorioamnionitis than the control group (P < 0.05), while there was no significant difference between the PROM duration ≥72 hours group and the PROM duration < 72 hours group (P > 0.05). Compared with the control group and the PROM duration < 72 hours group, the PROM duration ≥72 hours group had significantly higher incidence rates of pneumonia and intracranial hemorrhage in preterm infants; the PROM duration ≥72 hours group had a significantly higher incidence rate of congenital infection and a significantly longer mean length of hospital stay compared with the control group (P < 0.05), while there were no significant differences between the PROM duration ≥72 hours group and the PROM duration < 72 hours group (P > 0.05). The multivariate analysis showed that PROM duration ≥72 hours was an independent risk factors for pneumonia (OR=2.200, 95%CI: 1.386-3.492) and intracranial hemorrhage (OR=2.331, 95%CI: 1.420-3.827) in preterm infants.Conclusions PROM duration ≥72 hours significantly increases the risk of placental infection in mothers and it is an independent risk factor for pneumonia and intracranial hemorrhage in preterm infants.