摘要:
目的 探讨羊水胎粪污染(meconium-stained amniotic fluid,MSAF)与绒毛膜羊膜炎(chorioamnionitis,CA)对母婴感染的影响.方法 选择2014年7~12月北京妇产医院足月单胎分娩、有MSAF、同时进行了胎盘病理检查的新生儿为MSAF组,根据胎盘病理特点再分为合并CA组和无CA组.选择既往有胎盘病理检查结果且无MSAF的足月健康新生儿为对照组,分析MSAF与CA对母婴感染的影响.结果 共纳入MSAF组178例,其中合并CA组57例,无CA组121例,对照组42例.MSAF组CA发生率(32.0%,57/178)明显高于对照组(4.8%,2/42),差异有统计学意义(P<0.05).MSAF合并CA组和无CA组新生儿生后第1天白细胞计数分别为(29.4±8.9)×109/L和(22.8±4.8)×109/L,生后3d内C反应蛋白增高比例分别为36.8%(21/57)和15.7%(19/121),新生儿感染发生率分别为49.1%(28/57)和20.7%(25/121),胎粪吸入综合征发生率分别为28.1%(16/57)和8.3%(10/121),两组比较差异均有统计学意义(P<0.05);MSAF合并CA组与无CA组母亲中性粒细胞比例分别为(80.3±7.3)%和(76.4±7.6)%,分娩前后发热率分别为22.8%(13/57)和9.9%(12/121),宫腔感染发生率分别为8.8%(5/57)和0%(0/121),产后出血率分别为24.6%(14/57)和3.3%(4/121),差异均有统计学意义(P<0.05).结论 MSAF新生儿CA发生率高,可增加新生儿感染风险,同时母亲产时发热及宫腔感染率亦增加.%Objective To study the influences of meconium-stained amniotic fluid (MSAF) and chorioamnionitis (CA) on maternal and infant infection.Method From July to December 2014,full-term single birth newborns with MSAF born in our hospital were assigned into the MSAF group.According to the pathological characteristics of the placenta,they were further assigned into CA group and non-CA group.The healthy single birth full-term infants without MSAF were assigned into the control group.The influences of MSAF and CA on maternal and infant infection were analyzed.Result A total of 178 MASF cases were enrolled,including 57 cases with CA and 121 cases without CA.42 infants were in the control group.The incidence of CA with MSAF (32.0%,57/178) was significantly higher than the control group (4.8%,2/42) (P<0.05).The white blood cell counts on the first day of the CA group and non-CA group were (29.4±8.9)x 109/Land (22.8±4.8)x 109/L,respectively.36.8% of the CA group had increased CRP within 3 days after birth,while 15.7% in the non-CA group.The incidence of neonatal infection were 49.1%(28/57) in the CA group,and 20.7%(25/121) in the non-CA group.The incidence of meconium aspiration syndrome was 28.1%(16/57)in the CA group,and 8.3%(10/121) in the nou-CA group.The differences between the two groups were statistically significant (P<0.05).The proportion of neutrophils of the mother was (80.3±7.3)% in the CA group,and (76.4±7.6)% in the non-CA group.22.8%(13/57) of the mothers in the CA group had fever before and after delivery,and 9.9%(12/121) in the non-CA group.The incidence of uterine infection was 8.8%(5/57) in the CA group and 0%(0/121) in the non-CA group.The postpartum hemorrhage rate was 24.6%(14/57) in the CA group,and 3.3%(4/121) in the non-CA group.The differences were statistically significant (P<0.05).Conclusion The incidence of CA in MSAF neonates is higher,resulting increased incidences of neonatal infection,maternal fever,and uterine infection.