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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
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。
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.
Premature rupture of membranes / Latency period / Maternal infection / Preterm infant
[1] Zhou Q, Zhang W, Xu H, et al. Risk factors for preterm premature rupture of membranes in Chinese women from urban cities[J]. In J Gynaecol Obset, 2014, 127 (3): 254-259.
[2] 张瑞雪, 杨海澜, 籍静茹. 611例胎膜早破危险因素及妊娠结局的临床回顾性分析[J]. 中华妇幼临床医学杂志 (电子版), 2014, 10 (1): 53-56.
[3] Drassinower D, Friedman AM, Obi?an SG, et al. Prolonged latency of preterm premature rupture of membranes and risk of neonatal sepsis[J]. Am J Obstet Gynecol, 2015, 212 (1): S161-S162.
[4] 李玲, 吴金芝, 李萍,等. 未足月胎膜早破潜伏期对母婴结局的影响[J]. 中山大学学报 (医学科学版), 2013, 34 (4): 590-595.
[5] Nayot D, Penava D, Da SO, et al. Neonatal outcomes are associated with latency after preterm premature rupture of membranes[J]. J Perinatol, 2012, 32 (12): 970-977.
[6] Ekin A, Gezer C, Taner CE, et al. Risk factors and perinatal outcomes associated with latency in preterm premature rupture of membranes between 24 and 34 weeks of gestation[J]. Arch Gynecol Obstet, 2014, 290 (3): 449-55.
[7] Levy A, Wiznitzer A, Mazor M, et al. Factors affecting the latency period in patients with preterm premature rupture of membranes[J]. Arch Gynecol Obstet, 2011, 283 (4): 707-710.
[8] 吴连方. 胎膜早破[M]//曹泽毅. 中华妇产科学.第3版. 北京：人民卫生出版社, 2014: 485-486.
[9] Holzman C, Senagore PK, Wang J. Mononuclear leukocyte infiltrate in extraplacental membranes and preterm delivery[J]. Am J Epidemiol, 2013, 177 (10): 1053-64.
[10] Pappas A, Kendrick DE, Shankaran S, et al. Chorioamnionitis and early childhood outcomes among extremely low-gestational-age neonates[J]. JAMA Pediatr, 2014, 168 (2): 137-147.
[11] 邵肖梅, 叶鸿瑁, 邱小汕. 实用新生儿学[M]. 第4版. 北京: 人民卫生出版社, 2011: 308-889.
[12] Menon R, Boldogh I, Hawkins HK, et al. Histological evidence of oxidative stress and premature senescence in preterm premature rupture of the human fetal membranes recapitulated in vitro[J]. Am J Pathol, 2014, 184 (6): 1740-1751.
[13] Hackenhaar AA, Albernaz EP, da Fonseca TM. Preterm premature rupture of the fetal membranes: association with sociodemographic factors and maternal genitourinary infections[J]. J Pediatr (Rio J), 2014, 90 (2): 197.
[14] 邹志慧, 杨冰岩, 王维琼,等. 胎儿血管炎与新生儿呼吸窘迫综合征发生关系的研究[J]. 中国新生儿科杂志, 2014, 29 (4): 268-269.
[15] 中华医学会妇产科学分会产科学组. 胎膜早破的诊断与处理指南 (2015) [J]. 中华妇产科杂志, 2015, 50 (1): 161-167.
[16] Lu HY, Zhang Q, Wang QX, et al. Contribution of histologic chorioamnionitis and fetal inflammatory response syndrome to increased risk of brain injury in infants with preterm premature rupture of membranes[J]. Pediatr Neurol, 2016, 61: 94-98.e1.
[17] 张强, 卢红艳, 王金秀,等. 胎盘炎症及胎儿炎症反应综合征与早产儿脑损伤的关系研究[J]. 中国当代儿科杂志, 2015, 17 (3): 217-221.
[18] 徐建梅. 不同孕周未足月胎膜早破潜伏期对母婴结局的影响研究[J]. 中国妇幼保健, 2014, 29 (29): 4744-4746.
[19] Suliman S, Seopela L. Congenital and neonatal infections[J]. J De Pediatr, 2015, 75 Suppl 1 (2): S15.
[20] Viscardi RM. Perinatal inflammation and lung injury[J]. Semin Fetal Neonatal Med, 2012, 17 (1): 30-35.
[21] Drassinower D, Friedman AM, Obi?an SG, et al. Prolonged latency of preterm premature rupture of membranes and risk of neonatal sepsis[J]. Am J Obstet Gynecol, 2015, 214 (6): 743.e1-6.
[22] Cetin O, Ayd?n ZD, Verit FF, et al. Is maternal blood procalcitonin level a reliable predictor for early onset neonatal sepsis in preterm premature rupture of membranes[J]. Gynecol Obstet Invest, 2017, 82 (2): 163-169.
[23] Jobe AH. Effects of chorioamnionitis on the fetal lung[J]. Clin Perinatol, 2012, 39 (3): 441-457.
[24] Kim SK, Romero R, Savasan ZA, et al. Endoglin in amniotic fluid as a risk factor for the subsequent development of bronchopulmonary dysplasia[J]. Am J Reprod Immunol, 2013, 69 (2): 105-123.
[25] 李晓云, 汤慕群. 宫内感染与早产儿脑损伤发生的相关性[J]. 中国美容医学杂志, 2012, 21 (18): 239-240.
国家自然科学基金（81330016，81630038）；国家临床重点专科（儿科新生儿专业）建设项目（1311200003303）；四川省科技厅项目（2014SZ0149，2016TD0002）
