北京地区早产发生现状及早产儿结局的调查分析
북경지구조산발생현상급조산인결국적조사분석
Preterm birth and preterm infants in Beijing regional district
  • 万方数据
    中华妇产科杂志 중화부산과잡지
    CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
    2010年 2期 99-103 ,共5页

    郭战坤%马京梅%范玲%张运平%杨孜%时春艳%申林%马仲秋%王珈略%杨慧霞

    곽전곤%마경매%범령%장운평%양자%시춘염%신림%마중추%왕가략%양혜하

    早产%婴儿,早产%婴儿死亡率 早產%嬰兒,早產%嬰兒死亡率
    조산%영인,조산%영인사망솔
    Premature birth%Infant,premature%Infant mortality
    目的 探讨北京地区早产发生现状及不同孕周、不同类型早产儿的结局.方法 选择2006年12月1日-2007年5月31日在北京大学第一医院(北大一院)、首都医科大学附属北京妇产医院(市妇产医院)、北京市海淀区妇幼保健院(海淀妇幼)、北京大学第三医院(北大三院)住院分娩的孕28周～36周~(+6)早产产妇955例及其早产儿1066例为研究对象,4家医院同期分娩数为15 197例.结果 (1)早产发生率:早产总发生率为6.3%(955/15 197).其中北大三院的早产发生率为13.1%(150/1142),北大一院的早产发生率为8.1%(125/1549),市妇产医院的早产发生率为5.5%(369/6656),海淀妇幼的早产发生率为5.3%(311/5850).其中北大三院的早产发生率明显高于其他医院(P<0.01).两家综合医院(北大一院及北大三院)的早产率10.2%(275/2691)明显高于两家专科医院(市妇产医院及海淀妇幼)的早产率5.4%(680/12 506),两者比较,差异有统计学意义(P<0.01).(2)早产发生孕周:<34周的早产发生率为28.5%(272/954),≥34周的早产发生率为71.5%(682/954),早产主要发生在孕34周以后.各家医院的早产发生孕周分布有明显不同,其中,海淀妇幼<34周的早产发生率明显低于其他3家医院(P<0.01),北大一院<34周的早产发生率最高(P<0.05),北大三院与市妇产医院相比较,差异无统计学意义(P>0.05).(3)早产发生的原因:在早产的发生原因排序中,未足月胎膜早破(PPROM)早产占首位(405例),其次为医源性早产(340例)和自发性早产(205例).各医院早产发生的原因有所不同,北大三院的医源性早产率明显高于其他各医院(P<0.01);北大一院的PPROM发生率较高而自发性早产率较低.医源性早产的发生原因排序中前4位分别是子痫前期143例(42.0%),胎儿窘迫58例(17.1%),前置胎盘43例(12.6%),胎盘早剥33例(9.7%).(4)各家医院的早产儿结局比较:4家医院由于早产原因、孕周不同,其早产儿结局也存在较大差异,市妇产医院早产儿死亡率最高,为5.4%(22/408),与海淀妇幼(1.3%,4/320)及北大三院(0.6%,1/170)比较,差异有统计学意义(P<0.01);与北大一院(2.4%,3/124)比较,差异无统计学意义(P>0.05).(5)不同孕周的早产儿结局比较:<32孕周的早产儿治愈率显著低于≥32孕周者(P<0.01),≥34孕周的早产儿治愈率为99.6%.<32孕周的早产分娩家属放弃及早产儿死亡率显著高于332孕周者,其中,<32孕周的早产儿死亡率为22.1%,≥34孕周者仅为0.3%,两者比较,差异有统计学意义(P<0.01).(6)不同原因的早产儿结局比较:医源性早产的早产儿死亡率(4.9%)高于PPROM早产(1.6%),两者比较,差异有统计学意义(P<0.05).PPROM、自发性早产及医源性早产3者的早产儿治愈率相互比较,差异无统计学意义(P>0.05).结论 早产儿死亡率较高,尤其是<32孕周的早产儿死亡率更高,这部分早产儿是早产预防的重点;同时,减少医源性早产,积极预防PPROM早产的发生也是降低早产发生率的重要因素.
    목적 탐토북경지구조산발생현상급불동잉주、불동류형조산인적결국.방법 선택2006년12월1일-2007년5월31일재북경대학제일의원(북대일원)、수도의과대학부속북경부산의원(시부산의원)、북경시해정구부유보건원(해정부유)、북경대학제삼의원(북대삼원)주원분면적잉28주～36주~(+6)조산산부955례급기조산인1066례위연구대상,4가의원동기분면수위15 197례.결과 (1)조산발생솔:조산총발생솔위6.3%(955/15 197).기중북대삼원적조산발생솔위13.1%(150/1142),북대일원적조산발생솔위8.1%(125/1549),시부산의원적조산발생솔위5.5%(369/6656),해정부유적조산발생솔위5.3%(311/5850).기중북대삼원적조산발생솔명현고우기타의원(P<0.01).량가종합의원(북대일원급북대삼원)적조산솔10.2%(275/2691)명현고우량가전과의원(시부산의원급해정부유)적조산솔5.4%(680/12 506),량자비교,차이유통계학의의(P<0.01).(2)조산발생잉주:<34주적조산발생솔위28.5%(272/954),≥34주적조산발생솔위71.5%(682/954),조산주요발생재잉34주이후.각가의원적조산발생잉주분포유명현불동,기중,해정부유<34주적조산발생솔명현저우기타3가의원(P<0.01),북대일원<34주적조산발생솔최고(P<0.05),북대삼원여시부산의원상비교,차이무통계학의의(P>0.05).(3)조산발생적원인:재조산적발생원인배서중,미족월태막조파(PPROM)조산점수위(405례),기차위의원성조산(340례)화자발성조산(205례).각의원조산발생적원인유소불동,북대삼원적의원성조산솔명현고우기타각의원(P<0.01);북대일원적PPROM발생솔교고이자발성조산솔교저.의원성조산적발생원인배서중전4위분별시자간전기143례(42.0%),태인군박58례(17.1%),전치태반43례(12.6%),태반조박33례(9.7%).(4)각가의원적조산인결국비교:4가의원유우조산원인、잉주불동,기조산인결국야존재교대차이,시부산의원조산인사망솔최고,위5.4%(22/408),여해정부유(1.3%,4/320)급북대삼원(0.6%,1/170)비교,차이유통계학의의(P<0.01);여북대일원(2.4%,3/124)비교,차이무통계학의의(P>0.05).(5)불동잉주적조산인결국비교:<32잉주적조산인치유솔현저저우≥32잉주자(P<0.01),≥34잉주적조산인치유솔위99.6%.<32잉주적조산분면가속방기급조산인사망솔현저고우332잉주자,기중,<32잉주적조산인사망솔위22.1%,≥34잉주자부위0.3%,량자비교,차이유통계학의의(P<0.01).(6)불동원인적조산인결국비교:의원성조산적조산인사망솔(4.9%)고우PPROM조산(1.6%),량자비교,차이유통계학의의(P<0.05).PPROM、자발성조산급의원성조산3자적조산인치유솔상호비교,차이무통계학의의(P>0.05).결론 조산인사망솔교고,우기시<32잉주적조산인사망솔경고,저부분조산인시조산예방적중점;동시,감소의원성조산,적겁예방PPROM조산적발생야시강저조산발생솔적중요인소.
    Objective To investigate the incidence and relevant information of preterm birth and the outcomes of preterm infants delivered at various gestational weeks and for different causes. Methods Totally 955 women, who ended their pregnancies before term, and 1066 neonates of the previous mothers were enrolled in this survey, among 15 197 deliveries at Peking University First Hospital, Beijing Gynecological and Obstetric Hospital, Women's and Children's Hospital of Haidian District and Peking University Third Hospital, respectively, from December 1~(st), 2006 to May 31~(st), 2007. Results (1)Incidence of preterm birth: The overall incidence of preterm birth of the 4 hospitals was 6. 3% (955/15 197), and it was 8.1% (125/1549) in Peking University First Hospital, 13.1% (150/1142), which was the highest (P<0.01), in Peking University Third Hospital, 5.5% (369/6656) in Beijing Gynecological and Obstetric Hospital and 34.0% (311/5850) in Women's and Children's Hospital of Haidian District.The preterm birth rate at the two comprehensive hospitals was significantly higher than that of the two specialized hospitals [10.2% (275/2691) vs 5.4% (680/12 506), P <0.01]. (2) Gestational weeks at delivery: The incidence of preterm birth before 34 weeks was 28.5% (272/954) and the number changed to 71.5% (682/954)for those preterm deliveries after 34 weeks. However, this number varied among the 4 hospitals. Peking University First Hospital had the highest incidence of preterm birth before 34 weeks(P< 0.05), and the lowest was found in Women's and Children's Hospital of Haidian District(P<0.01), but no difference was found between Peking University Third Hospital and Beijing Gynecological and Obstetric Hospital. (3) Etiology of preterm birth: Preterm premature rupture of membranes (PPROM) accounted for the most proportion of all preterm birth cases, followed by iatrogenic preterm birth and spontaneous preterm birth. But the causes of preterm birth in the 4 hospitals were different. Peking University Third Hospital had a higher incidence of iatrogenic preterm birth than the others (P<0.01), and Peking University First Hospital had a higher incidence of preterm birth caused by PPROM and lower incidence of spontaneous preterm birth. The first four reasons of iatrogenic preterm birth were preeclampsia (143, 42.0%), fetal distress (58, 17.1%), placenta previa (43, 12.6%) and placenta abruption (33,9.7%). (4) Neonatal outcomes in different hospitals: The neonatal outcomes were quite different among the 4 hospitals due to different causes and different delivery weeks. The highest neonatal mortality rate was found in Beijing Gynecological and Obstetric Hospital (5.4%, 22/408) compared to that in Women's and Children's Hospital of Haidian District (1.3%,4/320) and Peking University Third Hospital (0. 6%, 1/170) (P< 0.01), but without any difference when compared to that in Peking University First Hospital (2.4%, 3/ 124) (P>0.05). (5) Neonatal outcomes at different gostational age: The recovery rate of preterm infants delivered at <32 weeks was lower than those delivered ≥32 weeks (P<0.01), and this number rose to 99. 6% in those delivered ≥34 weeks. More infants delivered <32 weeks were given up for treatment or died during the perinatal period than those delivered ≥32 weeks, with the neonatal mortality rate of 22.1% for those delivered at <32 weeks and only 0.3% for those delivered at ≥ 34 weeks (P<0.01). (6) Neonatal outcomes for various causes: The premature neonatal mortality rate for iatrogenic preterm births was higher than that of PPROM (4.9% vs 1.6%, P<0.05). But the neonatal recovery rates were similar among the PPROM, spontaneous and iatrogenic preterm birth group (P>0.05). Conclusions Preterm birth is associated with high perinatal mortality rate, especially for those delivered before 32 weeks which would be highlighted in prevention. Reduction of the iatrogenic preterm birth, combined with proper prevention of PPROM, is an important issue in decreasing the prevalence of preterm birth.
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