目的探讨倍他米松联合硫酸镁治疗未足月胎膜早破(PPROM)的临床效果。方法选取2022年10月至2024年2月菏泽市妇幼保健院收治的92例PPROM患者作为研究对象,根据随机数字表法分为对照组(46例)与研究组(46例)。对照组给予倍他米松治疗,研究组给予倍他米松联合硫酸镁治疗。比较两组的疗效指标、相关血清指标、新生儿肺功能、分娩结局及不良反应。结果研究组的持续治疗时间、宫缩抑制开始时间均短于对照组,孕龄延长时间长于对照组,产后出血量少于对照组,差异有统计学意义(P<0.05);两组患者治疗后的肿瘤坏死因子-α(TNF-α)、白细胞介素-2(IL-2)、基质金属蛋白酶-9(MMP-9)水平均低于本组治疗前,且研究组治疗后的TNF-α、IL-2、MMP-9水平均低于对照组,差异有统计学意义(P<0.05);研究组新生儿出生第1、7天的气道阻力均低于对照组,肺顺应性、功能残气量均高于对照组,差异有统计学意义(P<0.05);研究组的产妇宫内感染、新生儿出生窒息发生率低于对照组,新生儿出生体重及出生后5 min Apgar评分均高于对照组,差异有统计学意义(P<0.05);两组患者的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论倍他米松联合硫酸镁应用于PPROM患者治疗中,能够缩短治疗时间,延长孕龄,减少产后出血量,降低相关血清指标水平,改善分娩结局及新生儿肺功能,且不会增加不良反应。
胎膜早破(premature rupture of membrane, PROM)是指在临产前胎膜自然破裂。孕龄小于37孕周的胎膜早破又称为未足月胎膜早破。未足月胎膜早破(preterm premature rupture of membranes, PPROM)与一系列风险密切相关,如早产、胎儿肺部发育不良、羊水减少、胎儿骨骼发育异常、脑瘫,新生儿神经发育障碍、视网膜病变和支气管肺发育不良,以及产后出血、败血症及母亲的其他并发症等。PPROM的发病机制不明,目前认为是多种因素共同作用的结果,包括生殖道感染、羊膜腔压力过高、胎膜受力异常、外界刺激或外力影响,以及孕妇的营养状况等因素。其中,生殖道感染是导致PROM的主要原因。研究表明,阴道微生态平衡异常可导致病原菌的过度生长,增加胎膜早破的发生风险。Premature rupture of membranes (PROM) refers to the natural rupture of the fetal membranes before labor. The rupture of fetal membranes before 37 weeks of gestation is known as preterm premature rupture of membranes (PPROM). PPROM is closely associated with a series of risks, such as preterm birth, poor fetal lung development, decreased amniotic fluid, abnormal fetal skeletal development, cerebral palsy, neonatal neurodevelopmental disorders, retinopathy, bronchopulmonary dysplasia, as well as postpartum hemorrhage, sepsis, peripheral gangrene, and other maternal complications. The pathogenesis of preterm premature rupture of membranes (PPROM) is not fully understood, but it is currently believed to be the result of multiple factors, including genital tract infections, high amniotic cavity pressure, uneven stress on the fetal membranes, external stimulation or external force influence, and the nutritional status of pregnant women. Among them, genital tract infection is the main cause of PROM. Studies have shown that abnormal vaginal microecological balance can lead to excessive growth of pathogenic bacteria and increase the risk of premature rupture of membranes.
