晚期早产与早期足月双胎儿围生期情况差异的临床研究

Perinatal conditions of late preterm twins versus early term twins

摘要:

目的 探讨晚期早产双胎新生儿（LPT）及早期足月双胎新生儿（ETT）围生期常见临床合并症情况。方法 回顾性分析246例LPT及496例ETT孕母及新生儿期合并症情况，分析比较LPT发生的独立危险因素，并按胎龄分为34~34⁺⁶周组（n=44）、35~35⁺⁶周组（n=70）、36~36⁺⁶周组（n=132）、37~37⁺⁶周组（n=390）、38~38⁺⁶周组（n=106），比较各组新生儿围生期合并症情况。结果 孕母妊娠高血压、孕母血小板减少、前置胎盘和胎膜早破为LPT发生的独立危险因素（P < 0.05）。LPT组呼吸系统疾病、喂养不耐受、低血糖症等发生率均高于ETT组（P < 0.05）。34~34⁺⁶周组新生儿窒息发生率高于37~37⁺⁶周组、38~38⁺⁶周组，败血症发生率高于36~36⁺⁶周组（P < 0.0045）；34~34⁺⁶周组、35~35⁺⁶周组新生儿呼吸窘迫综合征、新生儿呼吸暂停、新生儿贫血发生率均高于其他3组，新生儿肺炎、低血糖症、败血症发生率高于37~37⁺⁶周组、38~38⁺⁶周组（P < 0.0045）；35~35⁺⁶周组喂养不耐受发生率高于36~36⁺⁶周组、37~37⁺⁶周组、38~38⁺⁶周组（P < 0.0045）；36~36⁺⁶周组低血糖症发生率低于34~34⁺⁶周组，高于37~37⁺⁶周组（P < 0.0045）。结论 相比于ETT，LPT围生期合并症发生率较高；不同胎龄LPT及ETT围生期合并症不同，应重视对不同胎龄双胎儿的个体化监测及合理治疗。

Abstract:

Objective To study the perinatal complications of late preterm twins(LPTs)versus early term twins(ETTs).Methods A retrospective analysis was performed for the complications of 246 LPTs,496 ETTs,and their mothers.The risk factors for late preterm birth were analyzed.According to gestational age,the twins were divided into five groups:34-34⁺⁶ weeks(n=44),35-35⁺⁶ weeks(n=70),36-36⁺⁶ weeks(n=132),37-37⁺⁶ weeks(n=390),and 38-38⁺⁶ weeks(n=106).The perinatal complications were compared between groups.Results Maternal hypertension,maternal thrombocytopenia,placenta previa,and premature rupture of membranes were independent risk factors for late preterm birth in twins(P<0.05).The LPT group had higher incidence rates of respiratory diseases,feeding intolerance,and hypoglycemia than the ETT group(P<0.05).The 34-34⁺⁶ weeks group had a higher incidence rate of neonatal asphyxia than the 37-37⁺⁶ weeks and 38-38⁺⁶ weeks groups;and had a higher incidence rate of septicemia than 36-36⁺⁶ weeks group(P<0.0045).The 34-34⁺⁶ weeks and 35-35⁺⁶ weeks groups had higher incidence rates of neonatal respiratory distress syndrome,neonatal apnea,and anemia than the other three groups;and had higher incidence rates of neonatal pneumonia,hypoglycemia and septicemia than the 37-37⁺⁶ weeks and 38-38⁺⁶ weeks groups(P<0.0045).The 35-35⁺⁶ weeks group had a higher incidence rate of feeding intolerance than the 36-36⁺⁶ weeks,37-37⁺⁶ weeks,and 38-38⁺⁶ weeks groups(P<0.0045).The 36-36⁺⁶ weeks group had a lower incidence rate of hypoglycemia than the 34-34⁺⁶ weeks group and a higher incidence rate of hypoglycemia than the 37-37⁺⁶ weeks group(P<0.0045).Conclusions Compared with ETTs,LPTs have an increased incidence of perinatal complications.The incidence of perinatal complications is associated with gestational ages in the LPTs and ETTs.