CAJ | 학술논문

目的：探讨不同孕周和不同类型早产的变化趋势，及其与早产相关因素、分娩方式、早产儿出生体质量、新生儿窒息的关系。方法：回顾性分析2008年1月-2012年12月在南京医科大学第一附属医院住院分娩的早产病例1466例，对不同孕周早产（妊娠早、中、晚期早产）和不同类型早产（自发性早产、治疗性早产）的变化趋势、早产相关因素、分娩方式、早产儿出生体质量及新生儿窒息率进行统计分析。结果：①2008-2012年早产的年发生率呈逐年升高趋势（χ2=65.69，P＜0.001），不同孕周早产发生率和不同类型早产发生率均呈升高趋势。②不同孕周自发性早产主要相关因素为胎膜早破、多胎妊娠、胎位异常、妊娠期糖尿病及不明原因等，不同孕周治疗性早产主要相关因素为妊娠期高血压疾病、胎盘因素、妊娠合并症、多胎妊娠、妊娠期肝内胆汁淤积症和胎儿窘迫等。③不同孕周早产的阴道分娩率和剖宫产率差异无统计学意义（P＞0.05），不同类型早产的阴道分娩率和剖宫产率差异有统计学意义（P＜0.05），治疗性早产剖宫产率高于自发性早产（P＜0.05）。④不同孕周早产的新生儿体质量和新生儿窒息率差异均有统计学意义（P＜0.05）。妊娠早期早产的新生儿窒息率（53.01%）高于中期早产（33.46%）和晚期早产（28.61%），差异有统计学意义（均P＜0.05），中期早产与晚期早产的新生儿窒息率差异无统计学意义（P＞0.05）。结论：应及早识别早产潜在高危因素，加强围生期管理，以减少早产的发生，改善围生儿结局。
목적：탐토불동잉주화불동류형조산적변화추세，급기여조산상관인소、분면방식、조산인출생체질량、신생인질식적관계。방법：회고성분석2008년1월-2012년12월재남경의과대학제일부속의원주원분면적조산병례1466례，대불동잉주조산（임신조、중、만기조산）화불동류형조산（자발성조산、치료성조산）적변화추세、조산상관인소、분면방식、조산인출생체질량급신생인질식솔진행통계분석。결과：①2008-2012년조산적년발생솔정축년승고추세（χ2=65.69，P＜0.001），불동잉주조산발생솔화불동류형조산발생솔균정승고추세。②불동잉주자발성조산주요상관인소위태막조파、다태임신、태위이상、임신기당뇨병급불명원인등，불동잉주치료성조산주요상관인소위임신기고혈압질병、태반인소、임신합병증、다태임신、임신기간내담즙어적증화태인군박등。③불동잉주조산적음도분면솔화부궁산솔차이무통계학의의（P＞0.05），불동류형조산적음도분면솔화부궁산솔차이유통계학의의（P＜0.05），치료성조산부궁산솔고우자발성조산（P＜0.05）。④불동잉주조산적신생인체질량화신생인질식솔차이균유통계학의의（P＜0.05）。임신조기조산적신생인질식솔（53.01%）고우중기조산（33.46%）화만기조산（28.61%），차이유통계학의의（균P＜0.05），중기조산여만기조산적신생인질식솔차이무통계학의의（P＞0.05）。결론：응급조식별조산잠재고위인소，가강위생기관리，이감소조산적발생，개선위생인결국。
Objective:To explore the variation tendency of different gestational weeks and types of prematurity and the relationship of preterm-related factors,mode of delivery,premature child birth weight and neonatal asphyxia. Methods:Retrospective analysis of 1 466 hospital delivery cases of preterm labor in the first Affiliated Hospital of Nanjing Medical University from January 2008 to December 2012. Statistical analysis of the tendency,the preterm-related factors,mode of delivery and the neonatal asphyxia of different gestational weeks of prematurity (early preterm,interim preterm,late preterm) and different types (spontaneous preterm birth,treatment of preterm labor). Results: ①From 2008 to 2012,the rate of preterm birth increased year by year (χ2=65.69,P<0.001),while varying periods preterm showed an increasing trend,different types of preterm birth tended to increase. ②Varying periods of spontaneous preterm relevant factors include premature rupture of membranes,multiple pregnancy,abnormal fetal position,gestational diabetes some other unexplained factors and so on;the varying periods of therapeutic premature factors include gestational hypertension,placental factors,pregnancy complications, multiple pregnancy,intrahepatic cholestasis of pregnancy,fetal distress and so on.③The vaginal delivery and cesarean section rate of different gestational weeks of preterm delivery was no significant difference (P>0.05),while was statistically significant difference (P<0.05) in different types of preterm delivery. The treatment of preterm cesarean section is higher than spontaneous preterm labor (P<0.05).④The Birth weight and neonatal asphyxia varying different periods of preterm birth have been statistically significant(P<0.05), early preterm children with neonatal asphyxia (53.01%) higher than interim (33.46%,P<0.05) and late preterm infants (28.61%,P<0.05),no significant difference in interim and late preterm children (P>0.05). Conclusions:We should discriminate the preterm potential risk factors earlier and strengthen the perinatal management to reduce the incidence of preterm birth and improve the perinatal outcomes.