医源性早产196例分析.DOCVIP

临床医学论文-医源性早产196例分析 【摘要】? 　目的 分析研究医源性早产相关的危险因素及早产儿发病及死亡的相关因素。方法 回顾分析2002 年1月～2007 年12 月我院196 例医源性早产的原因, 与487 例自然早产相比分娩方式和新生儿窒息的差异。比较28 ～31 + 6 周,32 ～34 + 6 周和35 ～36 + 6 周孕龄新生儿窒息和新生儿死亡的差异。结果 妊娠期高血压疾病、妊娠期肝内胆汁淤积症、前置胎盘、胎儿窘迫为引起医源性早产的最常见原因。医源性早产与自然早产组分娩方式和新生儿窒息发生率差异有显著性( P 0105) 。结论 医源性早产与孕期多种因素有关, 早产是围产儿发病和死亡的主要原因, 重视早产的临床相关因素, 降低围生儿并发症及死亡率。 【关键词】? 医源性早产; 妊娠结局; 围产儿; 预后 ??? ［Abstract］? Objective? To analyse and study the dangerous factors associated with iatrogenic premature labor and the etiology and reason of death inpremature infant.Methods? The causes of 196 cases of iatrogenic preterm labor from January 2002 to June 2007 in my hospital were analyzed retrospectively and 487 controls at spontaneous premature labor group，the delivery mode and neonatal asphyxia were compared.Compared neonatal asphyxia and neonatal death rate in patients at 28～31+6 weeks gestation，32～34+6 weeks gestation and 35～36+6 weeks gestation.Results? The most common causes of iatrogenic preterm delivery were hypertensive disorder complicating pregnancy，intrahepatic cholestasis of pregnancy，placenta praevia and fetal distress.Significant differnces was shown in the delivery mode and neonatal asphyxia rate between the two groups（P＜0.05）.Conclusion? There are many factors leading to iatrogenic premature labor during gestational period.Premature labor is main reason of disease and death in infantin controling the factor which caused premature labor in clinic and decreasing the complication and mortality in infant. ??? ［Key words］? iatrogenic proterm labor；pregnant prognosis；perinatal fetus；prognosis ??? 早产是围产儿死亡的主要原因之一，发生率为5%～15%。有医学指征需要早产分娩者称为医源性早产，临床上主要是指一些妊娠合并症或并发症。由于产科并发症或合并症的存在，继续妊娠将严重危及母婴安全，而提前终止妊娠者，也称干预性早产［1］。笔者就近6年来在我院发生的医源性早产做一回顾性分析，现报告如下。 ??? 1? 资料与方法 ??? 1.1? 一般资料? 2002年1月～2007年12月在我院分娩的孕妇20 693例，早产683例（不包括死胎分娩以及计划外妊娠引产），单胎594例，双胎89例，早产诊断以乐杰主编第6版《妇产科学》为准［2］。早产占总分娩数的3.3%，胎膜早破组302例，特发性早产185例，归为自然早产共487例；因产科合并症、并发症等医疗原因需立即终止妊娠而致早产的归为医源性早产共196例，占总分娩数的0.95%，占早产的28.70%（196/683）。年龄20岁2例、20～35岁627例、