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目的:分析不同孕周胎膜早破性早产(preterm premature rupture of membrane,PPROM)以及产前使用糖皮质激素干预对妊娠结局的影响。方法:对该院411例未足月胎膜早破早产病例的临床资料进行回顾性分析,比较不同孕周PPROM及产前是否使用糖皮质激素治疗的各种早产儿结局。结果:≤34孕周PPROM的新生儿体重、新生儿呼吸窘迫综合征(NRDS)、窒息发生率、死亡率均明显高于>34孕周的PPROM者(P<0.001)。32～34孕周组PPROM的新生儿重度窒息发生率、NRDS、死亡率在糖皮质激素干预组明显低于对照组,两组间比较差异有统计学意义(P<0.05)。28～31+6孕周组及34+1～36+6孕周组PPROM新生儿结局的各项指标在干预组与对照组间差异无统计学意义(P>0.05)。结论:对≤34孕周的PPROM宜采取积极期待治疗,延长孕周,降低新生儿死亡比。32～34孕周的PPROM产前使用糖皮质激素干预能显著改善新生儿结局。
Objective: To analyze the effect of preterm premature rupture of membrane (PPROM) and prenatal glucocorticoid intervention on pregnancy outcomes. Methods: The clinical data of 411 cases of preterm premature rupture of membranes in our hospital were retrospectively analyzed. The outcomes of PPROM in different gestational weeks and prenatal treatment with glucocorticoid were compared. Results: Neonatal body weight, neonatal respiratory distress syndrome (NRDS), asphyxia and mortality in PPROM ≤34 gestational weeks were significantly higher than those in PPROM> 34 gestational weeks (P <0.001). The incidence of severe neonatal asphyxia, NRDS and mortality in PPROM of 32-34 gestational weeks group were significantly lower than those of control group in the glucocorticoid intervention group, with significant difference between the two groups (P <0.05). There was no significant difference between the intervention group and the control group in 28 ~ 31 + 6 gestational age group and 34 + 1 ~ 36 + 6 gestational age group (P> 0.05). Conclusion: Positive expectant treatment should be taken for PPROM ≤34 gestational weeks to prolong gestational age and reduce neonatal death rate. PPROM prenatal intervention with glucocorticoid 32 to 34 gestational weeks can significantly improve neonatal outcome.