甲硝唑联合过氧化氢对产褥感染产妇白细胞、C-反应蛋白和降钙素原水平的影响

目的探究甲硝唑联合过氧化氢溶液冲洗宫腔配合抗菌药物对产褥感染产妇白细胞(WBC)、C-反应蛋白(CRP)和降钙素原(PCT)水平的影响。方法选择2016年9月至2018年12月重庆市开州区人民医院收治的产褥感染产妇120例,根据随机数表法分为观察组和对照组,每组60例。对照组产妇给予静脉滴注青霉素和口服氨苄西林的常规抗菌药物治疗,观察组患者在对照组用药基础上加甲硝唑联合过氧化氢溶液冲洗宫腔。分别检测两组观察对象全血WBC计数和血清CRP与PCT水平。结果产后1 d两组产妇全血WBC计数、血清CRP和PCT水平差异均无统计学意义(P均>0.05)。产后3 d和5 d,观察组患者WBC计数分别为(9.39±1.79)×10^9/L和(6.93±1.23)×10^9/L,显著低于对照组(12.05±2.33)×10^9/L和(9.93±1.94)×10^9/L],差异有统计学意义(t=7.03、P<0.001,t=10.05、P<0.001);观察组产妇血清CRP水平分别为(22.97±10.57)mg/L和(15.42±8.82)mg/L,显著低于对照组(31.67±12.59)mg/L和(20.86±10.83)]mg/L,差异均有统计学意义(t=3.92、P<0.001,t=2.98、P=0.01);观察组产妇血清PCT水平分别为(2.87±1.47)μg/L和(0.81±0.50)μg/L,显著低于对照组(3.78±1.90)μg/L和(1.68±0.99)μg/L],差异有统计学意义(t=2.96、P=0.01,t=5.92、P<0.001)。观察组产妇治疗后整体有效率为98.33%(59/60),显著高于对照组80.00%(48/60)],差异有统计学意义(χ^2=10.44、P<0.001)。多因素Logistic回归分析显示,治疗(OR=0.35、95%CI:0.15~0.87、P<0.01)为影响产褥感染临床疗效的保护因素,而孕期阴道炎病史(OR=3.49、95%CI:1.12~1.89、P=0.01)和年龄(OR=1.12、95%CI:1.02~1.19、P=0.01)均为影响产褥感染临床疗效的危险因素;第2产程延长并非产褥感染临床疗效的独立危险因素(OR=2.15、95%CI:1.01~5.11、P=0.08)。结论产妇发生产褥感染时,及时有效的抗感染干预措施是必需的,是影响产褥感染临床疗效的保护因素。采用甲硝唑联合过氧化氢溶液冲洗宫腔配合抗菌药物的治疗方式对已发生产褥感染者疗效较好。

Effects of metronidazole combined with hydrogen peroxide on levels of leukocytes,C-reactive protein and procalcitonin of parturients with puerperal infection

Objective To investigate the effect of flushing uterine cavity with metronidazole and hydrogen peroxide solution combined with antibiotics on levels of white blood cell(WBC),C-reactive protein(CRP)and procalcitonin(PCT)in puerperal infected parturients.Methods From September 2016 to December 2018,a total of 120 parturients with puerperal infection in Chongqing Kaizhou District People’s Hospital were selected and divided into observation group and control group according to the random number table method,with 60 cases in each group.The pregnant women in control group were given conventional antibiotics by intravenous infusion of penicillin and oral ampicillin;while the cases in observation group were treated with metronidazole combined with hydrogen peroxide solution to wash the uterine cavity based on the conventional treatment.The levels of WBC,serum CRP and PCT were detected,respectively.Results There were no significant differences in WBC count,serum CRP and PCT levels of maternal whole blood at 1 d postpartum between the two groups(all P>0.05).At the 3 d and 5 d postpartum,the WBC counts in the observation group were(9.39±1.79)×10^9/L and(6.93±1.23)×10^9/L,which were significantly lower than those of the control group(12.05±2.33)×10^9/L and(9.93±1.94)×10^9/L,respectively,with the significant differences(t=7.03,P<0.001;t=10.05,P<0.001).The maternal serum CRP levels in the observation group were(22.97±10.57)mg/L and(15.42±8.82)mg/L,respectively,which were lower than those of the control group(31.67±12.59)mg/L and(20.86±10.83)mg/L,respectively,with significant differences(t=3.92,P<0.001,t=2.98,P=0.01).At the 3 d and 5 d postpartum post-treatment,the serum PCT levels of the observation group were(2.87±1.47)μg/L and(0.81±0.50)μg/L,which were lower than those in the control group(3.78±1.90)μg/L and(1.68±0.99)μg/L],with significant differences(t=2.96,P=0.01;t=5.92,P<0.001).The overall effective rate of maternal treatment in the observation group was 98.33%(59/60),which was significantly higher than that in the control group80.00%(48/60)],with significant differences(χ^2=10.44,P<0.001).Multivariate Logistic regression analysis showed that treatment was a protective factor affecting the clinical efficacy of puerperal infection(OR=0.35,95%CI:0.15-0.87,P<0.01),but the history of vaginitis during pregnancy(OR=3.49,95%CI:1.12-1.89,P=0.01)and age(OR=1.12,95%CI:1.02-1.19,P=0.01)were both risk factors affecting the clinical efficacy of puerperal infection.Prolonged labor was not an independent risk factor for the clinical efficacy of puerperal infection(OR=2.15,95%CI:1.01-5.11,P=0.08).Conclusions When puerperal infection occurs,timely and effective anti-infection interventions were necessary.It was a protective factor affecting the clinical efficacy of puerperal infection.Metronidazole combined with hydrogen peroxide solution to wash uterine cavity combined with antibiotics was beneficial on patients with puerperal infection.