【摘要】  方针 探讨未足月胎膜早破的妊娠功效及临床处置。体例 对南方医科年夜学隶属花都病院2005年3月至2008年12月收治的124例未足月胎膜早破患者(其中孕28～33+6周26例为A组;孕34～36+6周98例为B组)的临床资料进行回首回头回忆性斗劲剖析。同时随机抽取同期住院妊娠足月无胎膜早破者248例作为斗劲组进行斗劲。功效 孕28～33+6周与孕34～36+6周未足月胎膜早破母亲产褥感染、产后出血、生产体例的斗劲，差别无统计学意义(P>0.05)。未足月胎膜早破组产后出血与足月生产组斗劲，二者差别有统计学意义(P<0.05)。孕28～33+6周匿伏期≤24 h与匿伏期>24 h斗劲，新生儿梗塞有差别有统计学意义(P<0.05)，孕34～36+6周匿伏期>24 h与匿伏期≤24 h斗劲，新生儿感染差别有统计学意义(P<0.05)。孕28～33+6周未足月胎膜早破新生儿梗塞。围产儿弃世亡率较着高于孕34～36+6周,差别有统计学意义(P<0.05)。结论 对分歧孕周的胎膜早破应接纳分歧的治疗体例。孕28～34周胎膜早破产妇，宜接纳期待疗法，经由过程切确应用提防感染、促进胎肺成熟及禁止子宫缩短等体例，以到达前进新生儿存活率，淘汰新生儿并发症之方针。选择合适生产机缘及生产体例，能获得精巧妊娠功效。

【关头词】  未足月胎膜早破;期待治疗;妊娠功效

Correlation factor analysis of clinical diagnosis and treatment of pregnancy preterm premature rupture of membranes

　　ZHANG Xiao-li,QIN Yi-wei,SUN Fang.Department of Obstetrics and Gynecology，Huadu Hospital Affiliated to South Medical University，Guangzhou 510800，China

　　[Abstract] Objective To analyze clinical management and pregnancy outcome in pregnancy complicated with preterm premature rupture of membranes(PPROM).Methods The clinical data of 124 patients with premature rupture of membranes in Huadu Hospital Affiliated to South Medical University from January 2005 to December 2008 were retrospectively studied.Twenty six patients with preterm premature rupture of the membranes at 28～33+6 weeks were selected as group A,while 98 patients with premature rupture of membranes at 34～36+6 weeks as group B.At the same time randomly selected full-term pregnancy with unbroken membranes hospitalized in the same period,248 cases was as contrast group for comparison.Results In patients at 28～33+6 weeks gestation compared with 34～36+6 weeks gestation on PPROM，the puerperal infection,postpartum hemorrhage and delivery methods was no statistically differences(P>0.05).The postpartum hemorrhage of PPROM group compared with the full-term delivery,the difference was statistically significant(P<0.05).The latent period≤24 hours compared with latent period>24 hours on the patients at 28～33+6 weeks of PPROM，the asphyxiated newborns was statistically differences(P<0.05).The latent period>24 hours compared with latent period≤24 hours on the patients at 34～36+6 weeks of PPROM，the neonatal infection was statistically differences(P<0.05).The asphyxiated newborns and perinatal mortality were higher in 28～33+6 weeks gestation than 34～36+6 weeks gestation，the difference was statistically significant(P<0.05).Conclusion The treatment scheme should be made according to the patients’ pregnant week，and modified to fit different patients.Pregnancy between 28 and 35 weeks’ gestation with preterm premature rupture of membranes should be managed expectantly to reduce neonatal complications，including the correct application of uterine contraction，steroids and antibiotics.We should pay more attention to PPROM in different gestational age，choosing the appropriate selection of the moment and proper delivery mode of terming pregnancy are help for mother and fetus.

　　[Key words] preterm premature rupture of membranes;expectant management;pregnancy outcomes

　　未足月胎膜早破(preterm premature rupture of membranes，PPROM)是指妊娠28～37周胎膜在临产前自然割裂。发病率近年有增添的趋向，因为其对母婴的风险，使临床处置变得巨年夜化而成为现在国内外较有争议的问题问题。PPROM的治疗难点，一方面要延长孕周淘汰新生儿因不成熟而发生的严重并发症甚至弃世亡;另一方面跟着破膜后时刻延长，上行性感染将不成禁止，同样可造成母儿预后不良。是以，PPROM的处置问题问题应引起产科事情者的高度重视。现将南方医科年夜学隶属花都病院2005年3月至2008年12月收治的PPROM病例进行回首回头回忆性剖析，以期追求适当的处置体例，获得写意的妊娠功效。

　　1 资料和体例

　　1.1 一样平常资料 选择南方医科年夜学隶属花都病院2005年3月至2008年12月收治合适PPROM诊断标准[1]124例，妊妇平均年龄(27.3±2.9)岁，平均孕周(33.1±0.5)周。生产新生儿132例(其中双胎8例)。将PPROM病例按孕周分为两组。A组:26例，妊娠28～33+6周。保胎3～30天平均时刻10天。生产新生儿28例，出现新生儿感染1例，新生儿轻度梗塞7例，新生儿重度梗塞5例，新生儿存活25例，弃世亡3例。B组:98例，妊娠34～36+6周。保胎时刻2～13天，平均3天。生产新生儿104例，出现新生儿感染2例，新生儿轻度梗塞8例，重度梗塞2例，全数存活。同时随机抽取同期住院妊娠足月无胎膜早破者248例作为斗劲组进行斗劲。凡妊娠晚期弃世胎、胎儿畸形、规画生育引产者均不计入内。

　　1.2 研究体例 确诊病例入院后重新核对孕周，按胎膜早破通例光顾帮衬护士，操纵抗生素提防感染及宫缩禁止剂，不够34周妊娠者通例予以地塞米松6 mg肌注2次/d，共2日促胎肺成熟。治疗历程中详尽不雅观察妊妇体温、脉搏、子宫压痛、胎动、胎心、羊水性状、血通例、C-反映卵白转变，超声动态监测渣滓羊水量、胎儿宫秘闻况及成熟度。

　　1.3 统计学处置 组间计量资料斗劲接纳t磨练，计数资料斗劲接纳χ2磨练，P<0.05为差别有统计学意义。全数数据均操纵SPSS 13.0统计软件包处置。