目的 探讨人工辅助生殖技术(assisted reproductive technology,ART)及自然受孕孪生早产儿临床结局。方法 收集医院2015-01至2020-12出生的孪生早产儿,共计364例(182对),根据受孕方式不同分为ART组和自然受孕组,ART组孪生156例(78对),自然受孕组孪生208例(104对)。对两组孪生早产新生儿期并发症情况进行回顾性分析,收集母孕期一般情况、并发症、孪生早产儿出生时孕周、Apgar评分、孪生体重及体重差值、出生后合并呼吸窘迫综合征(respiratory distress syndrome,RDS)、新生儿宫内感染性肺炎、新生儿低血糖症、院内感染、应用呼吸支持情况、应用中心静脉置管(PICC和(或)UVC)、Ⅲ~Ⅳ度颅内出血、动脉导管未闭(≥3.0 mm)、支气管肺发育不良(bronchopulmonary dysplasia,BPD)、早产儿视网膜病变(retinopathy of prematurity,ROP)、住院天数、应用静脉营养时间等信息,比较两组之间的差异。结果 ART组产妇年龄大于35岁为26.3%,高于自然受孕组(14.9%),ART组产妇孕期合并糖尿病、高血压、甲状腺功能减低症比例均高于自然受孕组,差异有统计学意义(P<0.05)。ART组早产儿出生发生重度窒息、合并新生儿呼吸窘迫综合征、宫内感染性肺炎的发生率、应用中心静脉置管[包括PICC和(或)UVC,χ2=4.015]和静脉营养的时间(t=5.626)均高于或长于自然受孕组,差异均有统计学意义(P<0.05)。结论 ART双胎早产儿易发生重度窒息、新生儿呼吸窘迫综合征和宫内感染性肺炎,需加强孪生早产新生儿围生期保健及管理,避免不良结局。
Abstract
Objective To investigate the artificial assisted reproductive technology (assisted reproductive technology,ART)and the clinical outcome of premature twins born naturally.Methods A total of 364 premature twins (182 pairs) hospitalized in pediatrics from January 2015 to December 2020 were collected, and divided into ART group (78 pairs) and natural pregnancy group (104 pairs) according to different pregnancy methods. The neonatal complications of twin preterm birth in the two groups were analyzed retrospectively. The general conditions of mother pregnancy, complications, gestational weeks of twin preterm birth, Apgar score, twin weight and weight difference, postnatal respiratory distress syndrome, neonatal intrauterine infectious pneumonia, neonatal hypoglycemia, nosocomial infection, application of respiratory support, application of Central venous catheterization (PICC and/or UVC), grade Ⅲ~Ⅳ intracranial hemorrhage,patent ductus arteriosus(≥3.0 mm), bronchopulmonary dysplasia(BPD), retinopathy of prematurity (ROP), length of hospital stay and time of intravenous nutrition were compared between the two groups.Results The maternal age of more than 35 years in the ART group (19.7%) was higher than that in the natural pregnancy group (14.2%). Gestational diabetes, hypertension and hypothyroidism in the ART group were higher than those in the natural pregnancy group, and the difference was statistically significant(P<0.05). The incidence of severe asphyxia and neonatal intrauterine infectious pneumonia in the ART group were higher than those in natural pregnancy group(χ2=5.317), and the incidence of BPD and central venous catheterization (including PICC and/or UVC, χ2=8.144) and the time of intravenous nutrition (t=2.073, P<0.05) were higher than those in natural pregnancy group (P<0.05) .Conclusions Premature twin infants with ART are prone to severe asphyxia, neonatal respiratory distress syndrome and intrauterine infectious pneumonia. Perinatal care and management of premature twin infants should be strengthened to avoid adverse outcomes.
关键词
双胎 /
并发症 /
早产儿 /
辅助生殖技术 /
新生儿
Key words
twins /
complication /
premature infant /
assisted reproductive technology /
the newborn
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参考文献
[1] Wenckus D J,Gao W,Kominiarek M A,et al.The efects of labor and delivery on maternal and neonatal outcomes in term twins:a retrospective cohort study[J].BJOG,2014,12l(9):l137-1114.
[2] Kullima A A,Audu B M,Geidam A D.Outcome of twin deliveries at the University of maiduguri teaching hospital:a 5-year review[J].Niger J Clin Pract,2011,14(3):345-348.
[3] 李思慧,龚景进,莫金桦,等.单、双胎早产的高危因素及早产儿结局比较研究[J].中国实用妇科与产科杂志,2018,34(2):171-175.
[4] Santana D S,Silveira C,Costa M L,et al. Perinatal outcomes in twin pregnancies complicated by maternal morbidity:evidence from the WHO multicountry survey on maternal and newborn health[J].BMC Pregnancy Childbirth,2018,18(1):449.
[5] Konno H,Murakoshi T,Yamashita A,et al.Roses of venovenous anastomosis and umbilical cord insertion abnormalities in birthweight discordance in monochorionic-diamniotic twin pregnancies without twin-twin transfusion syndrome[J].J Obstet Gynaecol Res,2018,44(4):623-629.
[6] 杨 蕊,李红真,乔 杰.辅助生殖技术对妊娠结局的影响及处置策略[J].中华围产医学杂志,2014,17(19):577-580.
[7] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].5版.北京:人民卫生出版社,2018:57-236.
[8] 余海燕,刘子建.单绒毛膜双胎妊娠的围产结局分析[J].中华妇产科杂志,2013,48(6):405-410.
[9] 范淑丽.试管婴儿孕妇的产科高危因素分析及护理体会[J].河北医学,2002,8(2):175-176.
[10] 程小侠,韩慧远,单丹娜,等.389例高龄经产妇妊娠相关问题及分娩方式对比分析[J].武警医学,2020,31(7):618-620.
[11] Lei L L,Lan Y L,Wang S Y,et al. Perinatal complications and live-birth outcomes following assisted reproductive technology:a retrospective cohort study[J].China Med J(Engl),2019,132(20):2408-2416.
[12] 武静静,张月莲.自然受孕、试管婴儿及促排卵受孕双胎妊娠临床结局研究[J].山西医科大学学报,2019,50(4): 493-496.
[13] 杨 悦.试管婴儿双胎妊娠与自然受孕双胎妊娠临床结果对比分析[J].泰山医学院学报,2017,38(12):1417-1418.
[14] 时娟娟,蔺 莉.妊娠合并甲状腺功能异常的相关问题研究[J]. 中国全科医学,2011,14(1B):113.
[15] 魏亚红.影响新生儿败血症预后的高危因素分析[J].临床医学研究与实践,2017,5(3):117-118.
[16] 吴齐爱,黄 涌,韦婷艳,等.新生儿败血症临床特点及其预后的影响因素[J].武警医学,2021,32(11):973-976.
[17] Bordi G D,Ambrosio A,Gallotta I,et al. The influence of ovulation induction and assisted conception on maternal and perinatal outcomes of twin pregnancies[J].Eur Rev Med Pharmacol Sci,2017,21(18):3998-4006.
[18] 张 丽,董彦会,马 军.试管双胎婴儿与自然妊娠双胎婴儿临床特征比较分析[J].中国儿童保健杂志,2016,24(11):1125-1127.
[19] Okun N, Sierra S. Pregnancy outcomes after assisted human reproduction[J].J Obstet Gynaecol Can,2014,36(1):64-83.
[20] Zhu C X,Wang M L,Niu G,et al.Obstetric outcomes of twin pregnancies at advanced maternal age:a retrospective study[J].Taiwan J Obstet Gynecol,2018,57(1):64-67.
[21] 黄小云,刘惠龙,雷 敏,等.胎龄27-40周双胎新生儿宫内生长状况研究[J].中国当代儿科杂志,2018,20(4):267-273.
[22] 王 华,武 玮,侯东敏,等.双胎晚期早产儿临床结局分析及受孕方式对其结局的影响[J].中华新生儿科杂志,2019,34(6):434-436.
[23] Shah J S,Nasab S H,Chappell N,et al.Neonatal outcomes among twins stratified by method of conception:secondary analysis of maternal fetal medicine (MFMU) network database[J],J Assist Reprod Genet,2018,35(6):1011-1017.
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