| 摘要: |
| 目的探讨抗生素使用时机对不同孕周胎膜早破母婴结局的影响。方法将384例未足月胎膜早破孕妇按破膜时孕周不同分为A组120例（孕28周~31周+6）、B组114例（孕32周~33周+6）和C组150例（孕34周~36周+6）；同时按破膜至使用抗生素的时间不同，将各组孕妇进一步分为＜6h、6~12h和＞12h组。比较各组母亲发生产褥病率、产后出血、绒毛膜羊膜炎以及新生儿发生宫内窘迫、窒息、呼吸窘迫综合征、高胆红素血症、败血症、死亡的比例。结果A组破膜后6h内使用抗生素，母亲发生绒毛膜羊膜炎、新生儿发生败血症的比例均最低（均P＜0.017）；破膜12h内使用抗生素，新生儿窒息发生率低于破膜12h后使用抗生素（均P＜0.017）；不同时间使用抗生素，母亲发生产褥病率、产后出血及新生儿发生宫内窘迫、呼吸窘迫综合征、高胆红素血症、死亡的比例比较，差异均无统计学意义（均P＞0.05）。B组破膜6h内使用抗生素，母亲发生产褥病率、产后出血、绒毛膜羊膜炎的比例以及新生儿发生宫内窘迫、呼吸窘迫综合征、高胆红素血症的比例均最低（均P＜0.017）；破膜12h内使用抗生素，新生儿发生窒息、败血症的比例均低于破膜12h后使用抗生素（均P＜0.017）。C组破膜12h内使用抗生素，母亲发生产褥病率、绒毛膜羊膜炎以及新生儿发生呼吸窘迫综合征、败血症的比例均低于破膜12h后使用抗生素；不同时间使用抗生素，母亲发生产后出血以及新生儿发生宫内窘迫、窒息、高胆红素血症的比例比较，差异均无统计学意义（均P＞0.05）。3组孕妇抗生素使用时机与破膜持续时间均无关（P＞0.05）。结论对于未足月胎膜早破的孕妇，尽早使用抗生素能减少母婴不良结局的发生。孕周＜34周的未足月胎膜早破，使用抗生素的最佳时机是破膜6h内；≥34周的未足月胎膜早破，使用抗生素的最佳时机是破膜12h内。 |
| 关键词: 胎膜早破 抗生素使用时机 母婴结局 |
| DOI：10.12056/j.issn.1006-2785.2018.40.13.2017-1443 |
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| Timing of antibiotic use on maternal and neonatal outcomes in pregnant women with prematural rupture of membranes |
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the Second Affiliated Hospital of Wenzhou Medical University
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| Abstract: |
| Objective To investigate the effect of timing of antibiotic use on maternal and neonatal outcomes in pregnant women with premature rupture of membranes. Methods Three hundred and eighty-four pregnant women with premature rupture of membranes were divided into three groups: 120 cases with gestation of 28~31 weeks+6(group A), 114 cases with 32~33 weeks+6(group B) and 150 cases with 34~36 weeks+6(group C). According to the timing of antibiotic use, the subjects were further divided into ＜6h, 6~12h and ＞12h subgroups. The incidence of puerperal morbidity, postpartum hemorrhage, chorioamnionitis, fetal distress, neonatal asphyxia, neonatal respiratory distress syndrome, neonatal hyperbilirubinemia, neonatal sepsis, and death
rate were compared among groups. Results In group A, antibiotics was used within 6h after rupture of membrane, the incidence of chorioamnionitis and neonatal sepsis was the lowest (all P＜0.017). Antibiotics was used within 12h after membrane rupture, the incidence of neonatal asphyxia was lower than that after 12h (all P＜0.017). There was no significant difference in the incidence of puerperal morbidity, postpartum hemorrhage and neonatal intrauterine distress, respiratory distress syndrome, hyperbilirubinemia, and death rate among all groups (all P ＞0.05). In group B, the incidence of puerperal morbidity, postpartum hemorrhage, chorioamnionitis and fetal distress, respiratory distress syndrome and hyperbilirubinemia was the lowest when the antibiotics was used within 6h after membrane rupture (all P＜0.017). Antibiotics was used within 12h after membrane rupture, the incidence of neonatal asphyxia and septicemia was lower than that after 12h(all P＜0.017). In group C, antibiotics was used within 12h after membrane rupture, the incidence of puerperal morbidity, chorioamnionitis and neonatal respiratory distress syndrome
and septicemia was lower than that after 12h. The incidence of postpartum hemorrhage, fetal distress, neonatal asphyxia and neonatal hyperbilirubinemia were not affected by timing of antibiotic use (all P ＞0.05). Conclusion Early use of antibiotics can reduce the incidence of adverse outcomes for premature rupture of membranes. The optimal time for antibiotic use was within 6 hours after the rupture, in women with＜34 gestational weeks, while in those over 34 weeks, the most appropriate timing of antibi- otics use is within 12 hours after membrane rupture. |
| Key words: Premature rupture of membranes Opportunity of antibiotic application Maternal and infant outcomes |
