外阴阴道假丝酵母菌病严重程度影响因素的Logistic回归分析

目的:分析外阴阴道假丝酵母菌病(VVC)疾病严重程度的相关影响因素。方法:将2011年8月~2015年8月就诊于天津医科大学总医院普通妇科门诊的237例重度VVC患者及同期490例轻中度VVC患者作为研究对象进行病例对照研究。采用Logistic回归模型进行单因素及多因素分析。结果:(1)单因素分析显示,年龄≥30岁(OR=0.658,95%CI为0.481~0.899,P=0.009)、已婚(OR=0.560,95%CI为0.394~0.794,P=0.001)、采用自然避孕法避孕(OR=0.588,95%CI为0.359~0.965,P=0.036)、有妊娠史(OR=0.565,95%CI为0.411~0.777,P=0.000)、有阴道分娩史(OR=0.557,95%CI为0.371~0.835,P=0.005)是重度VVC的保护因素。白假丝酵母菌感染(OR=5.678,95%CI为2.180~14.789,P=0.000)是重度VVC的危险因素。对食物、药物或花草过敏(OR=1.713,95%CI为0.982~2.988,P=0.058)是重度VVC的可疑危险因素。(2)多因素分析显示,白假丝酵母菌感染(OR=4.593,95%CI为1.700~12.414,P=0.003)以及对药物、食物或花草过敏(OR=2.172,95%CI为1.059~4.458,P=0.034)是重度VVC的独立危险因素。结论:白假丝酵母菌感染以及对药物、食物或花草过敏是重度VVC的独立危险因素。     

促红细胞生成素治疗新生儿缺氧缺血性脑病的疗效系统分析

目的从循证医学角度探讨促红细胞生成素治疗新生儿缺氧缺血性脑病(HIE)的临床疗效。方法检索中国期刊网、万方数据库、重庆维普、中国生物医学文献数据库及Pubmed,获得已发表的促红细胞生成素治疗新生儿HIE的相关文献。根据临床纳入和排除标准,利用Revman 5.1软件对符合纳入条件的文献进行合并分析,以评价促红细胞生成素治疗新生儿HIE后7、14、28d的新生儿神经行为评分及3、6个月发育指数评估的影响。结果共检索到符合条件的文献15篇纳入Meta分析,其中研究组共502例,对照组500例。治疗7d的Meta分析结果提示,OR=2.73(95%CI,0.73~4.73,Z=2.68,P=0.007;治疗14d的结果提示,OR=1.78(95%CI,0.84~2.73,Z=3.70,P=0.000 2;治疗28d的Meta分析结果提示,OR=2.34(95%CI,0.66~4.03,Z=2.73,P=0.006。3个月时的MDI、PDI Meta分析结果提示,OR=2.53(95%CI,1.72~3.72),2.48(95%CI,1.66~3.73),Z=4.70,4.40,P均0.000 1;6个月时,MDI、PDI的Meta分析结果提示,OR=2.85(95%CI,1.68~4.82),2.77(95%CI,1.67~4.72),Z=3.89,3.93,P均0.000 1。各研究的发表均无偏倚。结论促红细胞生成素治疗新生儿HIE能够明显改善新生儿的神经行为及促进智能发育。     

硫酸镁对窒息新生儿缺氧缺血性脑损伤保护作用的观察

新生儿窒息后缺氧缺血性脑损伤常遗留严重的后遗症。由于病因及发病机制复杂 ,尚无有效药物能改善这种损伤 [1 ] 。近年有许多实验室研究表明 ,硫酸镁具有神经保护作用 ,但临床应用报道尚少见 [2 ] 。本研究旨在探讨硫酸镁对窒息新生儿缺氧缺血性脑损伤的保护作用及安全性 ,为新生儿缺氧缺血性脑病的治疗提供新的思路。一、资料与方法1.病例选择 :2 0 0 0年 8月～ 2 0 0 1年 12月我院 NICU收住的患儿 ,符合以下条件入选 :(1)足月新生儿 ;(2 )生后1min Apgar评分≤ 7分或 5 m in Apgar评分≤ 6分 ;(3)无严重先天畸形 ;(4)孕母在产科无特殊…     

妊娠期高血压疾病患者新生儿出生体质量的影响因素分析

目的探讨妊娠期高血压疾病孕妇新生儿出生体质量的影响因素。方法对在复旦大学附属妇产科医院产前检查并分娩、明确诊断妊娠期高血压疾病的单胎235例孕妇和新生儿出生体质量的相关资料进行回顾性分析。结果 235例新生儿中,出生体质量2 500 g 60例(25.53%)、2 500~3 000 g 56例(23.83%),3 000 g119例(50.64%)。Pearson相关分析显示,胎盘质量与新生儿出生体质量相关(r=0.171,P0.05);logistic回归分析显示分娩孕周与低出生体质量的0R=2.79,95%CI:2.18~3.57;重度子痫前期是低出生体质量的独立危险因素(OR=12.37,95%CI:1.54~99.05,P0.05);不同妊娠期高血压患者孕次、流产史、疾病严重程度、户籍所在地、经济条件与新生儿出生体质量比较,差异有统计学意义(P0.05)。结论妊娠期高血压疾病患者的分娩孕周和重度子痫前期是影响新生儿体质量的独立危险因素。     

207例不孕症妇女焦虑抑郁影响因素分析

目的:研究不孕症女性出现焦虑和抑郁症状的影响因素。方法:采用自制调查问卷和焦虑自评量表(SAS)、抑郁自评量表(SDS)对207名不孕女性的焦虑抑郁的可能影响因素进行调查。结果:焦虑症状的危险因素包括年龄(OR=1.488,95%CI=1.174~1.886)和既往治疗费用(OR=1.635,95%CI=1.202~1.223);而居住地为城镇是焦虑症状的保护因素(OR=0.400,95%CI=0.194~0.825)。抑郁症状的危险因素为不孕年限(OR=1.532,95%CI=1.315~1.785)和具有较高的文化程度:高中及中专(OR=3.227,95%CI=1.578~6.599),大专及以上(OR=2.528,95%CI=1.242~5.367)。结论:年龄、既往治疗费用、居住地、文化程度、不孕年限是不孕妇女焦虑抑郁发生的影响因素。     

新生儿脑梗死的危险因素

目的 探讨影响新生儿脑梗死的危险因素,为预防新生儿脑梗死的发生提供理论根据.方法 以2002年1月至2010年12月在北京大学第一医院新生儿科住院的8840例患儿中经影像学检查诊断的44例新生儿脑梗死患儿为研究对象,以1∶4配比关系,随机选择出生年月、胎龄与脑梗死患儿相配对的175例本院出生的新生儿作为对照组,采用单因素及二分类Logistic回归方法分析新生儿脑梗死的危险因素.结果 本院住院新生儿的疾病构成比,新生儿脑梗死占5.0‰(44/8840);同期活产婴儿27 352例,有21例患儿发生新生儿脑梗死,新生儿脑梗死发生率为0.7‰,即1/1302(21/27 352).44例脑梗死患儿中,足月儿36例,早产儿8例.单因素分析发现,脑梗死组胎儿/新生儿缺氧和红细胞增多症的发生率分别为50.0％(22/44)和11.4％(5/44),高于对照组患儿[分别为27.4％(48/175)和2.9％ (5/175)],差异有统计学意义(x2=8.237,OR=2.646,95％CI:1.343～5.211,P=0.004;x2=5.838,OR=4.359,95％CI:1.203～15.796,P=0.030).纳入所有危险因素进行的二分类Logistic回归分析显示,胎儿/新生儿缺氧(OR=2.860,95％CI:1.415～5.782,P=0.003)、红细胞增多症(OR=4.319,95％％CI:1.136～16.427,P=0.032)、孕母妊娠期高血压疾病(OR=3.388,95 ％CI:1.174～9.778,P=0.024)是新生儿脑梗死的危险因素,差异有统计学意义.进一步将这3个高危因素的严重程度与新生儿脑梗死发生的关系进行具体分析,发现孕母妊娠期高血压疾病(x2=-2.074,P=0.038)、胎儿/新生儿缺氧程度(x2=-3.470,P=0.001)与新生儿脑梗死的发生正相关.结论 孕母妊娠期高血压疾病,新生儿红细胞增多症、胎儿/新生儿缺氧是导致新生儿脑梗死发生的重要危险因素,尤其是当孕母出现子痫前期、患儿出现重度缺氧时,更易导致脑梗死的发生.     

轻中度慢性高血压孕期血压维持和控制水平对母儿结局影响研究

目的 探讨妊娠期轻中度慢性高血压患者孕期血压维持和控制水平对母儿结局的影响。方法 对2012年1月至2016年12月5年间在北京大学第三医院接受规律产前检查并结束妊娠且资料完整的初始诊断为妊娠合并慢性高血压的302例临床观察资料进行分析,比较孕期血压(blood pressure,BP)维持和控制的不同水平组(A组血压130/80mm Hg、B组130~139/80~89mm Hg、C组140~149/90~99mm Hg、D组150~159/100~109mm Hg)的临床特征及重度高血压(sever hypertension)、伴蛋白尿的子痫前期(preeclampsia with proteinuria,PE-Pro)、重度子痫前期(sever preeclampsia,SPE)以及小于胎龄儿(small-For-gestational-age,SGA)的发生率。结果 慢性高血压血压分级影响分析:孕前或孕早期慢性高血压Ⅲ级患者在孕中期或孕晚期重度高血压和SPE的发生率比高血压Ⅰ级者高(P0.05),但对PE-Pro、SGA的发生率未见影响(P0.05)。孕前或孕早期慢性高血压Ⅲ级患者发生PE-Pro、SPE的孕周比高血压Ⅰ级者早(P0.05),但对重度高血压的发病孕周未见影响(P0.05)。孕期血压维持和控制水平分析:A组重度高血压、PE-Pro、SPE的发生率比B组低(P0.05),B组重度高血压的发生率比C组低(P0.05)。孕期血压维持和控制水平对SGA的发生率未见影响(P0.05)。多因素分析显示血压维持和控制水平影响重度高血压、PE-Pro、SPE的发生(OR=4.957,95%CI 1.409~17.443;OR=2.388,95%CI 1.446~3.944;OR=1.174,95%CI 1.666~6.047);孕前或孕早期出现蛋白尿(OR=17.693 95%CI 1.800~173.886)是SPE的独立影响因素。肥胖是SGA的保护因素(OR=0.099,95%CI 0.013~0.737),孕期体重增长、血压维持和控制水平是SGA的独立影响因素(OR=0.803,95%CI 0.657~0.982;OR=5.786,95%CI 1.542~1.703)。结论 慢性高血压轻中度孕妇孕期血压控制有利于降低重度高血压、子痫前期、重度子痫前期的发生,而且并不对SGA的发生造成影响。     

合并胎儿窘迫的早期早产危险因素及围产儿结局分析

目的:探讨合并胎儿窘迫的早期早产的相关危险因素及围产儿结局。方法:回顾性分析南京医科大学附属妇产医院2016年1月至2021年12月收治的927例早期早产(孕周<32周)患者的临床资料,按是否合并胎儿窘迫分为观察组(226例)和对照组(701例)。采用单因素及Logistic回归分析合并胎儿窘迫的早期早产的危险因素,同时比较两组新生儿结局。结果:Logistic回归分析示：脐血流异常((印)OR(正) 7.597,95%CI 3.610～15.991)、脐带异常((印)OR(正) 3.333,95%CI 1.979～5.613)、胎动异常((印)OR(正) 23.506,95%CI 8.975～61.568)、胎心率异常((印)OR(正) 31.870,95%CI 11.495～88.358)、妊娠期高血压疾病(HDP)((印)OR(正) 11.611,95%CI 5.302～25.425)、胎儿生长受限(FGR)((印)OR(正) 8.518,95%CI 4.212～15.801)是合并胎儿窘迫的早期早产的独立危险因素((印)OR(正)>1,P<0.05)。与对照组相比,观察组的剖宫产率较高,新生儿出生体质量、Apgar 1分钟和5分钟评分、出院体质量均较低,而新生儿在重症监护室住院天数增加,差异均有统计学意义(P<0.05)。结论:合并胎儿窘迫的早期早产增加剖宫产率,并影响新生儿出生结局。加强对脐血流异常、脐带异常、胎动异常、胎心率异常、HDP、FGR等高危人群的监测,降低<32孕周胎儿窘迫的发生率,有助于改善妊娠结局。     

产妇盆底功能情况调查及产科因素对盆底功能的近期影响分析研究

目的:探讨产后盆底功能情况及产科因素对盆底功能的近期影响。方法:调查2014年1~12月同仁医院分娩并于产后6~8周来院做检查的2023例妇女,出院小结和产后检查记录提取产科相关信息,进行盆底电生理评估,对产妇盆底功能与产科因素进行单因素及多因素分析。结果:2023例产妇产后6~8周盆底功能评估异常率为89.67%。单因素分析结果表明,产次≥2次、会阴切开、足月分娩和新生儿出生体质量≥3500 g的产妇盆底功能更差。多因素分析结果显示,产次≥2次的产妇(OR=2.529,95%CI 1.763~3.628)、新生儿出生体质量≥3500 g(OR=1.636,95%CI 1.184~2.262)、阴道分娩(OR=1.440,95%CI 1.068~1.941)是影响产妇盆底功能的高危因素。对于阴道分娩产妇,产次≥2次(OR=3.460,95%CI 2.059~5.828)、会阴切开(OR=2.297,95%CI 1.484~3.557)和足月分娩(OR=6.248,95%CI 1.824~21.399)是影响盆底功能的高危因素。结论:分娩后6~8周的产妇盆底功能损伤较严重;多产次、新生儿体质量较大和阴道分娩是影响产后6~8周产妇盆底功能的因素。对于阴道分娩者,多产次、足月分娩、会阴切开是另一个影响盆底功能的因素。产科医生应指导孕妇合理控制孕期体重,临近预产期指导孕妇进行kegel训练,降低会阴切开率,以降低盆底功能障碍性疾病发生率。     

非重度慢性高血压孕妇孕期血压控制水平对妊娠结局的影响

目的:探讨妊娠合并非重度慢性高血压患者孕期不同血压控制水平对妊娠结局的影响。方法:选取2010年1月~2016年10月在上海仁济医院正规产检并分娩的妊娠合并非重度慢性高血压孕妇303例,根据孕期平均舒张压将患者分为非严格控压组102例(平均舒张压≥90mm Hg)和严格控压组201例(平均舒张压90mm Hg)。比较两组的妊娠结局,进行多因素Logistic回归分析。结果:调整混杂因素后,非严格控压组的早产(37.3%vs 17.9%,a OR=2.39,95%CI为1.31~4.37)、胎儿宫内窘迫(12.7%vs 6.0%,a OR=2.60,95%CI为1.03~6.58)、小于胎龄儿(21.6%vs 10.4%,a OR=2.28,95%CI为1.08~4.81)和新生儿转入NICU(20.6%vs 6.0%,a OR=3.53,95%CI为1.47~8.46)发生率均显著高于严格控压组。结论:非重度慢性高血压孕妇孕期严格控制血压更利于改善妊娠结局。     

Influence of maternal,obstetric and fetal risk factors on the prevalence of birth asphyxia at term in a Swedish urban population

BACKGROUND: The influence of maternal, obstetric and fetal risk factors on the prevalence of birth asphyxia at term in a Swedish urban population. OBJECTIVE: To investigate risk factors for Apgar score-defined birth asphyxia, birth asphyxia with hypoxic-ischemic encephalopathy and birth asphyxia-related death/disability. MATERIAL AND METHODS: Retrospective case-control study in term neonates with birth asphyxia defined as Apgar score < 7 at 5 min. Cases originating from nonasphyctic causes (e.g. infection, maternal sedation) were excluded. Hypoxic-ischemic encephalopathy was diagnosed according to criteria by Sarnat. Maternal, obstetric and fetal risk factors were registered in 225 cases of birth asphyxia diagnosed in 42 203 live births occurring in the urban Swedish population studied. A matched control group was used for statistical evaluation. RESULTS: Asphyxia was associated with single civil status, OR = 7.1 (95%CI 2.0, 27.6); intrauterine meconium release, OR = 4.1 (95%CI 1.8, 9.8); operative delivery, OR = 8.7 (95%CI 3.4, 24.6); breech delivery, OR = 20.3 (95%CI 3.0, 416.5); oxytocin augmentation, OR = 2.9 (95%CI 1.4, 6.3); cord complication, OR = 15.8 (95%CI 2.1, 341.5); external compression to assist delivery OR = 6.2 (95%CI 1.3, 45.7); and cardiotocography score, OR = 0.5 (95%CI 0.4, 0.6). Normal fetal heart rate variability, OR = 0.4 (95%CI 0.2, 0.6), repeated late decelerations irrespective of amplitude or repeated variable decelerations, OR = 29.4 (95%CI 5.7, 540.8) or occasional late or variable decelerations, OR = 2.2 (95%CI 1.3, 3.8), and no accelerations, OR = 5.2 (95%CI 2.0, 16.4), were associated with asphyxia. Operative or instrumental delivery was more common in all three asphyxia groups compared with controls. Leanness was a risk factor for asphyxia and for hypoxic-ischemic encephalopathy. Maternal age, smoking and illnesses, time of delivery (day/night, seasonal) and previous caesarean section were not associated with birth asphyxia. CONCLUSIONS: An association between neonatal asphyxia and cardiotocography parameters, intrauterine meconium release, operative delivery, breech delivery, single civil status, oxytocin augmentation, cord complication, external compression to assist delivery and neonatal leanness was found. Abnormal fetal heart rate variability, repeated late decelerations irrespective of amplitude or repeated variable decelerations, occasional late or variable decelerations and no accelerations were associated with asphyxia.     

硬膜外分娩镇痛相关产时发热影响因素分析

目的:研究接受自控硬膜外镇痛(PCEA)分娩的产妇发生硬膜外分娩镇痛相关产时发热(ERMF)的影响因素.方法:回顾分析2019年4月至2020年8月在南京大学医学院附属鼓楼医院接受PCEA分娩镇痛的387例产妇的临床资料.根据产妇是否发生ERMF分为2组:ERMF组(81例)、对照组(306例),比较两组间基本信息、妊...     

Welchen Einfluss hat die subpartuale Asphyxie auf die spätere gesundheitliche Entwicklung?

This article describes the possibility of analyzing the effect of perinatal events on long-term health outcome by data linkage of perinatal databases with databases from school entrance examinations in Hesse, Germany, and proves the feasibility of this approach by reporting the results of a regional pilot study. Within this pilot study, the prognostic value of three perinatal parameters of asphyxia (Apgar score, fetal heart rate monitoring, and umbilical arterial blood pH) were evaluated with respect to long-term health outcome. The database of all children born in the years 1991 to 1994 in the Department of Obstetrics at the University Hospital of Marburg as well as the database of the school entrance examinations from the Public Health Department of Marburg-Biedenkopf in 1998 were used for the analyses. Using a probabilistic pseudonymized merging algorithm, 779 children could be identified in both databases. Drop-out analyses revealed that children with a 5-min Apgar score <7 were less likely to reach the school entrance examination (OR=0.38; 95%CI=0.18–0.77), a result which remained significant after exclusion of early neonatal deaths (OR=0.57; 95%CI=0.23–0.96). Children born with an umbilical blood pH ≤7.1 were more likely to be documented with an asphyxia-related diagnosis in the school entrance examination (OR=3.64; 95%CI=1.04–12.72), whereas pathological fetal heart rate tracings diagnosed by the obstetrician documenting the birth did not show any prognostic value.     

Big infants in the neonatal intensive care unit

OBJECTIVE: This study was undertaken to identify risk factors for prolonged neonatal intensive care unit (NICU) stay in macrosomic (> or = 4000 g) neonates. STUDY DESIGN: A population-based case-control study in which 799 cases of macrosomic neonates with a prolonged NICU stay were compared with macrosomic neonates without a prolonged stay (n = 1598). RESULTS: Significant risk factors included: 5-minute Apgar score less than 7: odds ratio (OR) = 43.1; fetal distress: OR = 3.0; birth length less than 20 inches: OR = 2.2; birth weight more than 5000 g: OR = 2.6; maternal diabetes: OR = 3.0; gestational age 37 to 38 weeks: OR = 2.2; cephalopelvic disproportion: OR = 2.5; primary cesarean: OR = 2.6; forceps/vacuum: OR = 1.7. No significant association was seen with labor induction/augmentation or dysfunctional/prolonged labor. CONCLUSION: Prolonged stay in macrosomic neonates was related to fetal distress measures and less to factors related to prolonged labor. Attention to intrapartum fetal status during labor with suspected macrosomia appears to be especially warranted.     

喉罩通气在新生儿复苏中的应用和评价

目的 初步观察喉罩通气应用于新生儿复苏的可行性、有效性和安全性. 方法将分娩后需正压通气复苏的新生儿369例随机分为喉罩组(205例)及面罩组(164例),比较两种方法的复苏效果及观察喉罩操作时间、一次放置成功率及不良反应等. 结果 (1)两组新生儿生后1 minApgar评分构成差异无统计学意义,生后5 min Apgar评分构成高分者喉罩组明显多于面罩组(x2=-3.39,P=0.001).喉罩总体复苏成功率明显高于面罩组(99.02%和84.15%,x2=28.76,P＜0.01),总体复苏通气时间明显短于面罩组[(36.4±23.7)s和(66.2±35.4)s](t=-8.66,P＜0.01);其中重度窒息患儿喉罩复苏成功率为7/9,面罩组6例均未能成功复苏而需改气管插管;1 minApgar评分4～5分的新生儿喉罩复苏成功率明显高于面罩组(100.00%和42.86%,x2=23.04,P＜0.01),通气时间短于面罩组[(54.6±33.6)s和(136.4±42.0)s](t=-4.45,P＜0.01);1 minApgar评分6～7分的新生儿复苏成功率两组差异无统计学意义.(2)喉罩一次放置成功率98.54%(202/205),放置时间平均为(7.8±2.2)s,不良反应有呕吐(4例)和胃食管反流(3例). 结论喉罩通气操作相对简单,容易掌握,在较重窒息患儿中使用效果优于面罩,可在一定程度上替代气管插管,尤其适于气管插管操作不熟练者使用.     

亚低温对新生儿缺氧缺血性脑损伤的保护作用——随机对照试验Meta分析

目的　评价亚低温对新生儿缺氧缺血性脑损伤的保护作用.方法 计算机检索Medline/PubMed(1977～2006年)医学数据库、荷兰医学文摘(Embase,1989～2006年)和OVID全文数据库、Cochrane系统评价数据库(2006年)、中国学术期刊网全文数据库(CNKI,1994～2006年)、中国生物医学文献数据库(CBMdisc,1978～2006年)和国家科技图书文献中心等文献数据库,收集亚低温治疗新生儿缺氧缺血性脑损伤的临床研究和系统评价,进行质量评价,并对符合纳入标准的临床研究进行Meta分析. 结果 共查阅到国内外相关临床研究18篇,纳入随机对照研究4篇,其中国外3篇,国内1篇,均为高质量研究(Jadad评分均为3分).纳入研究均描述了随机化方法,但均未使用盲法.各组研究随访12～18个月,报道了病死率和严重伤残的发生率,均描述了失访情况.合并分析表明,与普通治疗组比较,亚低温组病死率OR=0.64,95%CI为0.46～0.90,P=0.01;严重伤残发生率OR=0.57,95% CJ为0.37～0.86,P=0.008;严重伤残和病死的合并发生率OR=0.50,95% CI为0.36～0.69,P<0.01,差异均有统计学意义. 结论 从现有临床证据看,亚低温可降低新生儿缺氧缺血性脑损伤后严重伤残发生率和病死率,但仍需大规模、高质量、随访结局统一的临床试验进一步验证.     

妊娠期开展“孕妇学校”课程对新生儿结局影响的研究

目的:分析妊娠期开展“孕妇学校”课程对于新生儿结局的影响。方法:回顾性分析2018年10月—2019年8月在中国人民武装警察部队特色医学中心（我院）产科住院的单胎孕足月且妊娠期规律产检的孕妇资料,根据其妊娠期参加“孕妇学校”课程次数分为观察组高组（≥7次课程）、中组（4~6次课程）、低组（≤3次课程）及对照组（未参加课程）,各组分别有53例、56例、48例和69例孕妇纳入研究。观察各组新生儿结局指标,包括新生儿体质量、脐动脉血pH值、脐动脉血乳酸水平、出生后Apgar评分、胎粪吸入综合征（meconium aspiration syndrome,MAS）发生率、缺血缺氧性脑病（hypoxic ischemic encephalopathy,HIE）发生率、坏死性小肠炎（necrotizing enteritis,NEC）发生率及转入新生儿科率。结果:观察组高、中、低组在新生儿体质量、新生儿脐动脉血乳酸水平方面均低于对照组,差异均有统计学意义（P<0.05）;观察组高、中组在新生儿脐动脉血pH值、出生后1 min Apgar评分方面均高于对照组,差异有统计学意义（P<0.05）。观察组高、中、低组在新生儿出生后5 min Apgar评分、出生后10 min Apgar评分、新生儿发生MAS、HIE、NEC率及转入新生儿科率方面与对照组差异无统计学意义（P>0.05）。结论:妊娠期开展“孕妇学校”课程在一定程度上可以改善新生儿体质量、脐动脉血pH值、脐动脉乳酸水平及出生后1 min Apgar评分,值得孕期广泛开展。     

Factors associated with umbilical artery acidemia in term infants with low Apgar scores at 5 min

Objective

To evaluate predictors of umbilical artery acidemia in term neonates with low Apgar score.

Study design

From a cohort of term singleton deliveries over a 13-year period, we selected neonates with 5-min Apgar score <7. Acidemia was defined as umbilical artery pH < 7.00 or base excess (BE) ≤−12 mmol/L. Three pathogenic processes of neonatal acidemia were evaluated: (1) intrauterine vascular disease, defined as preeclampsia, clinical diagnosis of placental abruption, birth weight <10th centile, or histologic evidence of placental infarction or severe vascular pathology, (2) intrauterine infection, defined as clinical chorioamnionitis, histologic chorioamnionitis, or early neonatal sepsis, and (3) acute intrapartum events, which included cases of cord prolapse, amniotic fluid embolism, uterine rupture, sudden and sustained fetal bradycardia or absence of FHR variability with a previously normal pattern, shoulder dystocia or complicated breech extraction. The associations of such processes with umbilical artery evidence of acidemia were tested using χ², Fisher's exact test, Student's t-test, and logistic regression, with P < 0.05 or odds ratio (OR) with 95% confidence interval (CI) not inclusive of the unity considered significant.

Results

Among the 27,395 neonates in the cohort, an Apgar score at 5 min <7 was recorded in 94 (0.32%) and it was associated with umbilical artery acidemia in 33 cases. Logistic regression analysis showed that intrauterine vascular disease was independently associated with umbilical cord acidemia (P = 0.035, OR = 3.2, 95% CI = 1.1–9.7) whereas intrauterine infection (OR = 1.1, 95% CI 0.4–3.4) and acute intrapartum events (OR = 2.1 95% CI 0.6–7.0) were not.

Conclusions

Umbilical artery evidence of acidemia is present in 38% of term babies with low Apgar score and it is predominantly associated with chronic antepartum vascular disease. Neither intrauterine infection nor acute intrapartum events are significantly associated with umbilical artery acidemia.     

脐血乳酸水平及胎心监护图形预测胎儿窘迫的价值

目的　探讨新生儿脐动脉血乳酸水平及胎心监护图形预测胎儿窘迫的价值。方法　测定 73例胎心监护图形为不良图形 (胎心基线异常、重度变异减速、轻度变异减速、心动过速 )的新生儿(病例组 )和 118例产前无胎儿窘迫征象 ,出生后 1分钟Apgar评分≥ 9分的新生儿 (对照组 )出生后脐动脉血乳酸水平。结果　病例组中产钳助产率明显高于对照组 (P <0 0 1) ,顺产率低于对照组 (P<0 0 1)。病例组中 ,胎心重度变异减速多发于第二产程 ;胎心基线异常的新生儿Apgar评分≤ 7分的发生率高于重度变异减速、轻度变异减速、心动过速的新生儿 (P <0 0 5 )。病例组中 ,胎心基线异常者脐动脉血乳酸水平为 (4 5 5± 0 2 3 )mmol/L ;重度变异减速者为 (3 84± 0 40 )mmol/L ,出现以上两种图形的新生儿脐动脉血乳酸水平均明显高于对照组 (P <0 0 1)。轻度变异减速者脐动脉血乳酸水平为 (2 63± 0 3 2 )mmol/L ;心动过速者脐动脉血乳酸水平为 (2 5 5± 0 46)mmol/L。并且轻度变异减速与心动过速者脐动脉血乳酸水平与对照组比较 ,差异无显著性 (P >0 0 5 )。结论　测定新生儿脐动脉血乳酸水平是一种有效、准确的诊断胎儿窘迫的方法。胎心基线异常、重度变异减速与胎儿窘迫的发生密切相关 ;轻度变异减速、心动过速与胎     

Umbilical blood gas analysis in preeclamptic versus healthy pregnancies with preterm birth

Objective: Comparing the value of umbilical cord arterial blood gas (UC-ABG) analysis in the prediction of neonatal mortality and morbidity in the preeclamptic versus healthy pregnancies with preterm birth.

Methods: Eight hundred sixteen preterm (born at?<37 gestational weeks) neonates with no other morbidities who were born by cesarean section were evaluated. Immediately after delivery, UC-ABG analysis was performed and the neonates were followed.

Results: Preeclamptic women had lower umbilical cord blood (UCB) pH (7.2 4?±?0.1 versus 7.2 7?±?0.08, p?=?0.008) and higher UCB base deficit (BD) (3.5?±?3.7 versus 2.2?±?3.4, p?=?0.005) compared with controls. In the preeclamptic group, UCB metabolic acidosis (pH?<?7.15 and B.D?>?8) was not independently associated with neonatal morbidity or mortality, while in the control group UCB metabolic acidosis was independently associated with low 10-min Apgar (OR, 4.9; 95%CI 1.37–18.03), respiratory distress syndrome (OR, 2.37; 95%CI 1.05–6.17), intraventricular hemorrhage (OR, 3.01; 95%CI 1.13–7.99), and neonatal mortality (OR, 17.33; 95%CI 4.51–66.53).

Conclusions: The preterm neonates born to preeclamptic mothers have lower UCB pH and higher BD. In these neonates, UCB acidosis is not independently associated with any adverse neonatal outcomes. In contrast, in the preterm neonates born to healthy mothers, UCB metabolic acidosis is independently associated with neonatal mortality and morbidity.