北京市七家三级甲等医院宫内感染病例分析

目的 了解北京市部分医院宫内感染发生的概况及其菌群分布特点,并探讨对母儿预后的影响. 方法 回顾性分析北京市七家三级甲等医院2007年1月1日至2007年12月31日所有出院诊断为宫内感染的176例病历资料,按分娩孕周分为早产组(77例)和足月组(99例),比较两组的一般情况、临床表现、实验室检查和母儿感染结局.分析细菌培养中常见的菌群分布,以及宫内感染与母儿结局的相关性. 结果 2007年七家医院宫内感染病例数占该年总分娩数的0.67%(176/26 204),早产孕妇的宫内感染发生率为3.91%(77/1969),其中早产胎膜早破(PPROM)占84.4%(65/77).早产组与足月组比较,剖宫产率(16.9%和61.6%)、胎膜早破(PROM)(85.7%和33.3%)和人工破膜(1.3%和61.6%)的发生率和破膜至分娩的时间均有统计学差异.两组母体产褥感染发生率分别为2.6%(2/77)和3.0%(3/99),新生儿感染的发生率分别为25.9%(20/77)和30.3%(30/99),差异均无统计学意义.早产组新生儿病死率为7.8%(6/77),明显高于足月组(P<0.05).最多见的宫内感染菌群为大肠埃希菌,占培养阳性者的37.3%(22/59),其次为B族链球菌,占32.2%(19/59),第三为葡萄球菌,占23.7%(14/59). 结论 早产孕妇宫内感染发生率高,围产儿预后差.常见的宫内感染菌群为大肠埃希菌和B族链球菌,应针对菌群选择敏感抗生素.

Intrauterine infection and the perinatal outcomes in seven tertiary hospitals in Beijing

Objective To investigate the distribution of different flora, and to explore the effect of intrauterine infection (IUI) on perinatal outcomes in some hospitals in Beijing. Methods A retrospective analysis was conducted on 176 IUI cases, which were divided into preterm (n=77) and term group (n=99), from 7 tertiary hospitals in Beijing from January 1, 2007 to December 31, 2007. The basic information, clinical presentations, laboratory tests results and placenta pathology reports of all cases were collected and analyzed. Analysis of the microbial population was perfomed according to the results of bacterial culture and the relationship between IUI and the perinatal outcomes was tested. Results The incidence of IUI in 2007 was 0.67% among all deliveries (176/26 204) and 3.91% of all preterm deliveries(77/1969), and 84. 4% of the preterra women were complicated with preterm premature rupture of fetal membranes (PPROM) (65/77). Significant difference was found between the two groups in the incidence of cesarean section, premature rapture of fetal membrane and artificial rupture of fetal membrane, and duration from membranes rupture to delivery (P<0.05). Neither the rate of puerperiurn infection 3.0% (3/99) vs 2.6% (2/77)] nor the neonatal infection rate 30.3%(30/99) vs 25.9%(20/77)] in the term and preterm group showed significant difference. The rate of neonatal death was higher in the preterm group than in the term group(7.8% vs 0,P<0.05). The primary infected bacteria was E. coli, which accounted for 37.3% (22/59) of those with positive results of culture, followed by group B streptococcus(GBS) 32.2%(19/59)] and Staphylococci 23.7%(14/59)3. Conclusions The incidence of IUI is higher in preterm labor women, especially those with PPROM. The common bacteria of chorioamnionitis are E. coli and GBS. Sensitive antibiotics should be administered according to bacterial culture results.