摘要
目的 探讨胎盘早剥(placental abruption,PA)合并绒毛膜羊膜炎(chorioamnionitis,CAM)对新生儿近期结局的影响.方法 收集2017年6月至2022年12月青岛大学附属医院出生且母亲行胎盘病理检查的早产儿临床资料进行回顾性分析,根据胎盘情况分为PA组、CAM组、PA+CAM组,采用x2检验或Fisher精确概率法进行组间比较.结果 共纳入115例,PA组38例,CAM组47例,PA+CAM组30例,3组间性别、胎龄、出生体重、低出生体重儿、5 min Apgar评分≤7分、住院时间比较,差异无统计学意义(P＞0.05).与PA组、CAM组相比,PA+CAM组患儿有创通气(30.0％比2.7％、0.0％)、肺表面活性物质应用(26.7％比5.3％、2.1％)、不良结局(76.7％比44.7％、48.9％)、死亡(20.0％比0.0％、2.1％)比例更高,差异有统计学意义(P＜0.05).PA+CAM组凝血功能异常比例(16.7％比0.0％)高于CAM组(P＜0.05),与PA组比较差异无统计学意义(P＞0.05).3组患儿支气管肺发育不良、呼吸窘迫综合征、呼吸衰竭、颅内出血、脑白质损伤、坏死性小肠结肠炎、输血、贫血、早发型败血症发生率比较,差异均无统计学意义(P＞0.05).3组患儿实验室检验结果pH值、BE值、白细胞计数、血小板计数、C反应蛋白水平比较,差异均无统计学意义(P＞0.05).结论 与单独存在PA、CAM的早产儿相比,PA合并CAM的早产儿需要有创通气、应用肺表面活性物质、不良结局、死亡的可能性更高.
Abstract
Objective To study the effects of placental abruption(PA)combined with chorioamnionitis(CAM)on short-term clinical outcomes of premature infants.Methods From June 2017 to December 2022,clinical data of premature infants born to mothers with placental pathology were retrospectively analyzed.The infants were assigned into three groups:PA group,CAM group and PA+CAM group.Chi-square test or Fisher's exact test was used for statistical analysis.Results A total of 115 cases were enrolled,including 38 in PA group,47 in CAM group and 30 in PA+CAM group.No significant differences existed in gender,gestational age,birth weight,proportion of low birth weight infants,5 min Apgar score ≤7 and length of hospital stay among the three groups(P＞0.05).PA+CAM group had significantly higher incidences of invasive ventilation(30.0％vs.2.7％,0.0％),pulmonary surfactant(PS)use(26.7％vs.5.3％,2.1％),adverse outcomes(76.7％vs.44.7％,48.9％)and death(20.0％vs.0.0％,2.1％)than PA group and CAM group(P＜0.05).The percentage of coagulation abnormalities was higher in PA+CAM group than CAM group(16.7％vs.0.0％,P＜0.05),while the difference was not statistically significant when compared with PA group(P＞0.05).No significant differences existed among the three groups in the following incidences:bronchopulmonary dysplasia,respiratory distress syndrome,respiratory failure,intracranial hemorrhage,white matter damage,necrotizing enterocolitis,blood transfusion,anemia and early-onset sepsis(all P＞0.05).Also,no significant differences existed in lab results including pH value,BE,white blood cell count,platelet count and C-reactive protein(P＞0.05).Conclusions Premature infants with PA combined with CAM have a higher risk of invasive ventilation,PS use,adverse outcomes and death compared with infants with PA or CAM alone.
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