胎膜早破对超早产儿早期预后的影响

Influence of premature rupture of membranes on the early prognosis of extremely premature infants

摘要:

目的 探讨胎膜早破（PROM）对超早产儿早期预后的影响，为超早产儿管理、产前咨询提供依据。方法 收集2017~2019年单胎超早产儿179例为研究对象，按是否存在PROM分为PROM组（69例）和非PROM组（110例），对孕母情况及患儿早期预后指标进行统计分析。结果 PROM组早发型败血症和坏死性小肠结肠炎发生率高于非PROM组（P < 0.05），肺表面活性物质使用率及血流动力学显著的动脉导管未闭发生率低于非PROM组（P < 0.05）。多因素logistic回归分析显示绒毛膜羊膜炎是早发型败血症、坏死性小肠结肠炎的独立危险因素（分别OR=11.062、9.437，P < 0.05），PROM是使用肺表面活性物质的独立保护因素（OR=0.363，P < 0.05）。结论 PROM增加了超早产儿早发型败血症及坏死性小肠结肠炎的发生率，未增加其他不良结局发生率。对有超早产风险的PROM孕妇，建议积极保胎、预防绒毛膜羊膜炎以延长孕周、降低感染发生率，从而改善超早产儿结局。

Abstract:

Objective To study the influence of premature rupture of membranes (PROM) on the early prognosis of extremely premature infants, and to provide a basis for the management of extremely premature infants and prenatal consultation. Methods A total of 179 extremely premature singleton infants who were born from 2017 to 2019 were enrolled. According to the presence or absence of PROM, they were divided into two groups: PROM group (n=69) and non-PROM group (n=110). A statistical analysis was performed for maternal data and early prognostic indicators. Results Compared with the non-PROM group, the PROM group had significantly higher incidence rates of earlyonset sepsis and necrotizing enterocolitis (NEC) (P < 0.05) and significantly lower rate of use of pulmonary surfactant and incidence rate of hemodynamically significant patent ductus arteriosus (P < 0.05). The multivariate logistic regression analysis showed that chorioamnionitis was an independent risk factor for early-onset sepsis and NEC (OR=11.062 and 9.437 respectively, P < 0.05), and PROM was an independent protective factor against the use of pulmonary surfactant (OR=0.363, P < 0.05). Conclusions PROM increases the incidence rates of early-onset sepsis and NEC in extremely premature infants and does not increase the incidence rates of other adverse outcomes. For pregnant women with PROM at the risk of extremely preterm delivery, prevention of miscarriage and chorioamnionitis is recommended to prolong gestational weeks, reduce the incidence rate of infection, and thus improve the outcome of extremely premature infants.