胎膜早破合并绒毛膜羊膜炎与极早产儿呼吸窘迫综合征的相关性研究

 目的 探讨孕母胎膜早破(PROM)合并绒毛膜羊膜炎与极早产儿呼吸窘迫综合征(NRDS)发生的相关性。方法 回顾性分析2016年6月-2019年6月在新生儿重症监护病房收治的胎龄<32周新生儿病历资料,根据孕母是否发生PROM分为对照组和PROM组,PROM组再根据孕母是否被确诊为绒毛膜羊膜炎分为PROM合并绒毛膜羊膜炎组(PROM感染组)和PROM未合并绒毛膜羊膜炎组(PROM无感染组),比较三组极早产儿临床资料,探讨孕母发生PROM后是否并发绒毛膜羊膜炎对新生儿NRDS发生、发展的影响。结果 共纳入早产儿284例,对照组136例,NRDS发病率74.3%(101例);PROM无感染组97例,NRDS发病率68.0%(66例);PROM感染组51例,NRDS发病率82.4%(42例);PROM无感染组与对照组极早产儿NRDS发病率比较,差异无统计学意义(χ²=1.080,P=0.299);PROM感染组与PROM无感染组极早产儿NRDS发病率比较,差异有统计学意义(χ²=3.471,P=0.062)。通过胃液泡沫试验、肺表面活性物质(PS)使用次数、使用呼吸机情况及PS使用后复查胸片情况来比较NRDS疾病的严重程度,结果发现PROM无感染组极早产儿NRDS发病程度较轻,有创呼吸机使用率(26.0%)较低;使用PS后PROM无感染组极早产儿复查胸片未见NRDS表现者比率(88.0%)较高,无重度NRDS者;而PROM感染组极早产儿复查胸片仍可见重度NRDS表现者比率(9.5%)较高,需多次使用PS,且有创呼吸机使用率(73.8%)最高。结论 PROM合并绒毛膜羊膜炎可能是NRDS发病的危险因素,且影响NRDS发病的进展与预后。

Relationship between premature rupture of membranes combined with chorioamnionitis and respiratory distress syndrome in very preterm infants

Objective To investigate the relationship between premature rupture of membranes (PROM) combined with chorioamnionitis and neonatal respiratory distress syndrome (NRDS) in very preterm infants (VPIs).Methods Medical records of newborns with gestational age < 32 weeks in a neonatal intensive care unit (NICU) from June 2016 to June 2019 were retrospectively analyzed, according to whether the pregnant mother had PROM, newborns were divided into control group and PROM group, PROM group was subdivided into PROM with chorioamnionitis group (PROM infection group) and PROM without chorioamnionitis group (PROM non-infection group).Clinical data of three groups of VPIs was compared, effect of chorioamnionitis after PROM on the occurrence and development of NRDS was explored.Results A total of 284 preterm infants were included in study, 136 were in control group, incidence of NRDS was 74.3%(n=101);97 cases were in PROM non-infection group, incidence of NRDS was 68.0%(n=66);51 cases were in PROM infection group, incidence of NRDS was 82.4%(n=42);there was no significant difference in the NRDS incidence between VPIs in PROM non-infection group and control group (χ²=1.080, P=0.299);there was significant difference in NRDS incidence between VPIs in PROM infection group and PROM non-infection group (χ²=3.471, P=0.062).The severity of NRDS was compared through gastric foam test, pulmonary surfactant (PS) use times, ventilator use and chest radiography re-examination result after PS use, the results showed that disease condition of NRDS in VPIs in PROM non-infection group was milder, and the invasive ventilator use rate was lower (26.0%); after PS use, the proportion of no-NRDS in chest radiography re-examination was higher (88.0%) in VPIs in PROM non-infection group, and there was no severe NRDS; the proportion of severe NRDS in chest radiography re-examination in PROM infection group was still higher (9.5%), multiple use of PS was necessary, and the use rate of invasive ventilator was the highest (73.8%).Conclusion PROM combined with chorioamnionitis may be a risk factor for NRDS, which may affect the progression and prognosis of NRDS.