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目的:了解干预性早产病因构成及其影响新生儿预后的相关因素。方法:选取2007年1月至2011年12月在新疆医科大学第一附属医院产科因母儿因素进行干预性早产的288例患者作为研究组,选取同期正常足月分娩271例及自发性早产274例作为对照组。采用单因素及多因素Logistic回归分析两组的早产儿结局。结果:常见需干预性早产的母儿因素有妊娠期高血压疾病321例(48.86%)、前置胎盘68例(10.35%)、妊娠期肝内胆汁淤积症(ICP)39例(5.93%)、妊娠合并内外科疾病71例(10.81%)、胎盘早剥52例(7.91%)等。自发性早产组与干预性早产组的终止妊娠孕周无显著差异[(34.044±1.996)周vs(34.229±1.622)周,P=0.229];而新生儿体重、Apgar评分与转NICU率、新生儿病率则差异显著(P均<0.05)。单因素分析结果显示,分娩孕周、妊娠期高血压病变、血压值、浮肿程度、尿蛋白定量、自觉症状、前置胎盘、胎盘早剥、胎儿窘迫、胎儿生长受限(FGR)、未正规产检、新生儿体重、Apgar评分、转NICU治疗情况与新生儿不良结局有关。多因素非条件Logistic回归分析显示,影响新生儿预后的危险因素为:定期产前检查、分娩孕周、FGR、胎儿窘迫、新生儿体重、出生时Apgar评分(P均<0.05)。结论:干预性早产儿体重越低、胎龄越小,严重并发症的发生率越高、死亡率越高。FGR、胎儿窘迫是围产儿预后的独立危险因素,提示预后不良,继续延长孕周无益。定期产检可降低妊娠合并症及并发症的发生率,是围产儿预后的保护因素;选择干预性早产的时机,适当增加孕周及出生体重对改善围产儿结局有益。
Objective: To understand the causes of interventional preterm etiology and its related factors that affect the prognosis of newborns. Methods: From January 2007 to December 2011 in the First Affiliated Hospital of Xinjiang Medical University, obstetric and gynecological factors for interventional preterm birth of 288 patients as a study group, select the same period of 271 cases of normal full-term labor and spontaneous preterm delivery of 274 Cases as a control group. Univariate and multivariate Logistic regression analysis of the two groups of preterm children outcome. Results: The common maternal and child factors requiring interventional preterm birth were gestational hypertension (321 cases, 48.86%), placenta previa 68 cases (10.35%), intrahepatic cholestasis of pregnancy (ICP) 39 cases (5.93%), 71 cases (10.81%) with internal and external diseases in pregnancy, 52 cases (7.91%) of placental abruption and so on. There was no significant difference in the gestational weeks of termination of pregnancy among the spontaneous preterm and intervention preterm groups [(34.044 ± 1.996) vs (34.229 ± 1.622) weeks, P = 0.229]; while the neonatal weight, Apgar score, Children’s disease rate was significantly different (P <0.05). Univariate analysis showed that gestational age, gestational hypertension, blood pressure, edema, urinary protein, symptoms, placenta previa, placental abruption, fetal distress, fetal growth restriction (FGR) Birth control, neonatal weight, Apgar score, NICU treatment and adverse neonatal outcomes. Multivariate non-conditional logistic regression analysis showed that the risk factors affecting the prognosis of newborns were regular antenatal examination, gestational gestational age, FGR, fetal distress, newborn weight and Apgar score at birth (all P <0.05). Conclusions: The lower the body weight, the smaller the gestational age, the higher the incidence of serious complications and the higher the mortality in interventional premature infants. FGR, fetal distress is an independent risk factor for perinatal prognosis, suggesting a poor prognosis, continue to extend the benefits of gestational age. Regular birth control can reduce the incidence of complications and complications of pregnancy, perinatal prognosis is the protective factor; select the timing of interventional premature delivery, appropriate gestational age and birth weight to improve perinatal outcome.