摘要
目的探讨产时发热与宫内感染的临床特点,以鉴别非宫内感染性产时发热,降低产时剖宫产率。方法回顾性分析2013年9月—2014年9月首都医科大学附属北京妇产医院收治的因产程中发热(持续体温升高≥37.5℃),可疑宫内感染行急诊剖宫产终止妊娠产妇病例140例的临床资料,记录其临床症状、体征及实验室检查指标,分析非宫内感染性产时发热与宫内感染产时发热的特点。寻找影响非宫内感染性产时发热的因素以及判断非宫内感染性产时发热的指标。结果 140例产时发热产妇中,77例(55.00%)确诊宫内感染产时发热,63例(45.00%)为非宫内感染性产时发热。产时发热非宫内感染者体质指数(BMI)、胎膜早破发生率高于宫内感染者,潜伏期破水发生率、胎心监护基线平直或频发中重度变异减速及晚期减速发生率、白细胞计数(WBC)低于宫内感染者,胎膜破水时间短于宫内感染者(P<0.05)。多因素Logistic回归分析结果显示,高BMI、低WBC、低C反应蛋白(CRP)是非宫内感染性产时发热的危险因素(P<0.05)。BMI、WBC、CRP判断非宫内感染性产时发热的ROC曲线下面积分别为0.608、0.648、0.595,差异均有统计学意义(P<0.05);BMI为30.6 kg/m^2时,灵敏度为88.3%,特异度为28.6%;WBC为16.1×10~9/L时,灵敏度为68.8%,特异度为58.7%;CRP为22.6 mg/L时,灵敏度为58.4%,特异度为63.5%。结论高BMI、低WBC、低CRP与非宫内感染性产时发热相关,尚没有理想的高灵敏度及高特异度实验室指标与宫内感染鉴别,需要临床医生综合判断。
Objective To explore the characteristics of intrapartum fever and intrauterine infection,identify non-infectious intrapartum fever and reduce cesarean section rate. Methods A retrospective analysis of the clinical data of 140 cases of pregnant women who were hospitalized in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from September 2013 to September 2014 and had pregnancy termination by emergency cesarean delivery due to intrapartum fever（ temperature remaining≥37. 5 ℃） which was suspected as intrauterine infection. We recorded clinical symptoms,physical signs and laboratory parameters and analyzed the features of non- infectious fever and infection-induced fever. The influencing factors for non-infectious fever and indexes predicting non- infectious fever were investigated. Results Among the 140 pregnant women who had intrapartum fever,77（ 55. 00%） patients were definitely diagnosed as intrauterine infection and 63（ 45. 00%） patients had no intrauterine infection. Pregnant women who had non-infectious fever had higher BMI,higher incidence rate of premature rupture of membranes,lower incidence rate of incubation period rupture,lower incidence rate of fetal heart rate monitoring accompanied by baseline straight or frequent moderate- to- severe variable deceleration and lower WBC and had shorter rupture of membranes than those who had infection- induced fever（ P〈0. 05）. Multivariate Logistic regression analysis showed that high BMI,low WBC and low CRP were risk factors for non- infectious fever（ P≤0. 05）. The AUC values of BMI,WBC and CRP diagnosing non- infectious fever were 0. 608,0. 648 and 0. 595 respectively（ P≤0. 05）; when BMI was 30. 6 kg / m2,the sensitivity and specificity were 88. 3% and 28. 6% respectively; when WBC was 16. 1 × 10 ^9/ L, the sensitivity and specificity were 68. 8% and 58. 7% respectively; when CRP was 22. 6 mg / L,the sensitivity and specificity were 58. 4% and 63. 5% respectively. Conclusion High BMI,low WBC,low CRP are related with non- infection fever. There are still no ideal laboratory indexes with high sensitivity and specificity to identify intrapartum fever induced by intrauterine infection,thus clinicians need to make comprehensive judgment.
出处
《中国全科医学》
CAS
CSCD
北大核心
2016年第14期1715-1718,共4页
Chinese General Practice
关键词
产时发热
宫内感染
剖宫产术
Intrapartum fever
Intrauterine infection
Cesarean section
作者简介
通信作者：王欣，100026北京市，首都医科大学附属北京妇产医院；E-mail：wx1501@aliyun．com
