单胎妊娠早产胎膜早破呼吸窘迫综合征的危险因素分析

目的:探讨单胎妊娠早产胎膜早破发生新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的危险因素。方法:选择2017年5月至2019年5月在我院产科分娩的2810例产妇为研究对象,其中97例(3.45%)符合未足月胎膜早破(Preterm premature rupture of membranes,pPROM)标准,包括53例RDS。收集以下信息:PROM潜伏期、出生时胎龄、脐动脉搏动指数(Umbilical artery pulsatility index,UAPI)、大脑中动脉搏动指数(Middle cerebral artery pulsation index,MCAPI)、胎儿窘迫、产前使用类固醇、新生儿实验室参数、性别、体重、Apgar评分、分娩类型、妊娠高血压疾病、妊娠期糖耐量异常或糖尿病等信息,通过Logistic回归分析研究变量对RDS的影响。结果:Logistic回归分析结果显示,以下变量与RDS密切相关:新生儿性别女性(OR=0.517;95%CI:0.312-0.107;P=0.042),产前使用类固醇(OR=0.467;95%CI:0.355-0.698;P0.001),异常UAPI(OR=2.830;95%CI:1.783-6.234;P=0.002),异常MCA PI(OR=2.136;95%CI:1.120-4.017;P=0.032),胎儿窘迫(OR=2.420;95%CI:1.287-4.824;P=0.017),母体HGB(OR=0.689;95%CI:0.511-1.013;P=0.221),新生儿HGB(OR=0.752;95%CI:0.645-0.891;P0.001),新生儿RBC(OR=0.311;95%CI:0.201-0.565;P0.001)。结论:单胎妊娠早产胎膜早破发生RDS危险因素主要是性别、胎儿胎盘循环异常和胎儿窘迫。

Risk factors of Premature Rupture of Fetal Membranes with Respiratory Distress Syndrome

ABSTRACT Objective: To explore the risk factors of RDS in premature ruptured fetal membranes in singleton pregnancies. Methods: From May 2017 to May 2019, 2810 cases of obstetrics who gave birth were delivered in our hospital, of which 97 cases (3.45 %) met the pPROM standard, including 53 cases of RDSA. The following information was collected: PROM latency, gestational age at birth, umbilical artery pulsatility index (UAPI), middle cerebral artery pulsation index (MCAPI), fetal distress, prenatal steroid use, neonatal laboratory parameters, gender, weight, Apgar score, type of delivery, pregnancy-induced hypertension, abnormal glucose tolerance during pregnancy, or diabetes, and the influence of study variables on RDS by Logistic regression analysis. Results: Logistic regression analysis showed that the following variables were closely related to RDS: neonatal gender female (OR=0.517; 95%CI: 0.312-0.107; P=0.042), prenatal steroid use (OR=0.467; 95% CI: 0.355-0.698; P<0.001), abnormal UAPI (OR=2.830; 95%CI:1.783-6.234; P=0.002), abnormal MCAPI (OR=2.136; 95 %CI:1.120-4.017; P=0.032), fetal distress (OR=2.420; 95 %CI: 1.287-4.824; P=0.017), maternal HGB(OR=0.689; 95 %CI: 0.511-1.013; P=0.221), neonatal HGB(OR=0.752; 95 %CI: 0.645-0.891; P<0.001), neonatal RBC (OR=0.311; 95 %CI: 0.201-0.565; P<0.001). Conclusion: Gender, fetal placental circulation abnormalities and fetal distress are risk factors for premature rupture of fetal membranes in singleton pregnancies.