【作者】 杨李梅；

【导师】 陈必良；

【作者基本信息】 第四军医大学 ， 妇产科学， 2004， 硕士

【摘要】 研究背景与目的：早产的发生率为5％～15％，早产儿中有15％于新生儿期死亡，除去致死性畸形，75％以上围产儿死亡与早产有关。近年来，虽然我国围产保健工作和产科干预措施有很大程度提高，但早产的发病率却未见明显降低。因此探索现代生活条件下早产的发病原因，对于降低婴儿死亡率，提高人口素质尤为重要。国内外的医务工作者对早产的危险因素进行了不同程度的流行病学研究，但不同国家和地区早产危险因素的作用程度也不完全一致。本研究对在第四军医大学西京医院分娩早产儿的产妇和足月产产妇进行成组病例对照研究，以期探索早产的危险因素，为制定预防策略和措施提供理论依据。 方法：2002年6月至2003年12月在第四军医大学西京医院住院分娩的连续产妇，共得到调查问卷1071份。早产组的纳入标准是：妊娠足28周至不满37周终止者：排除人工引产者，最终进入早产组111例。对照组的选择：从同期住院分娩的产妇中排除早产产妇后，将其余产妇进行编号，从中随机产生120例对照；排除过期妊娠者，最终进入对照组117例。采用成组病例对照研究，用非参和卡方检验的方法对55项早产的可疑危险因素进行单第四军医大学硕士学位论文因素分析，筛选出早产危险因素;进一步对其进行多因素logistic回归分析，筛选出早产主要危险因素;并计算主要危险因素的人群归因危险度;用McNulnar卡方检验，针对重复调查的病例，比较两次调查结果中主要危险因素的一致性.结果:单因素分析，得到17项早产危险因素，分别是:孕妇年龄小、家庭月经济收入低于1000元、引流产3次以上、初中以下文化程度、妊娠合并贫血、妊高征、妊娠合并心脏病、孕期负性生活事件、早产史、暴露视频终端、孕期接触有毒物质、首次产检时间晚于12周、产前检查次数较少、孕期严重噪音污染、孕期每天打手机时间大于smin、孕妇高血压家族史、多胎妊娠。 经进一步多因素logistic回归分析发现:暴露视频终端每天超过2.5h(oR=5.1，95%Cl=1.7一15.4)、孕期接触有毒物质(oR= 136.7，95%Cl=9 .9一1889.6)、负性事件(OR==4 6.1，95%Cl=2.7-771.4)、妊高征(oR=‘.7，95%Cl=1.1一19.2)、早产史(OR= 159.5，95%Cl=2.5一10205.8)，其人群归因危险度分别是7%、28%、 8%、29%、11%。 在全部1071例病例中随机产生30例，另请一位临床工作人员进行重复调查，McNumar卡方检验分析上述五项早产主要危险因素在前后两次调查中的一致性达到97%~100%。结论:孕期暴露视频终端时间较长，孕期接触有毒物质、负性生活事件、妊高征和早产史是早产的主要危险因素。早产病例中由于孕期较长时间暴露于视频终端引起的占7%;由于孕期接触有毒物质引起的占28%;由于孕期负性生活事件引起的占8%;由于妊高征引起的占29%;由于孕妇有早产史引起的占11%。另外本研究中重复调查的高一致性说明设计的问卷项目清晰、明确，结果可信度高。更多还原

【Abstract】 SETTING AND AIM: The incidence of premature is from 5 percent to 15 percent. Fifteen percent of premature infants die during the neonatal days, Apart from the abnormality which can cause death, more than 75 percent of dead perinatal infants are associated with premature delivery. In recent years, more obstetrical examination and prenatal care have been improved greatly in our country, but the incidence of premature doesn’t fall remarkably. Therefore, it is necessary to seek after the etiology of premature in modern life so that infant mortality can be reduced and population diathesis can be enhanced. The studies on the risk factors for preterm delivery have been performed to various degrees all over the world, but these factors varied from country to country. We conducted a case control-study in the obstetrical department of Xijing Hospital in order to explore the risk factors for premature, and these factors provide a more definable target population for better prenatal care. METHOD: One thousand and seventy one women wereinvestigated who delivered from June 2002 to December 2003 in Xijing Hospital, the Fourth Military Medical University. One hundred and eleven premature patients were selected who delivered at gestation age between 28-37 weeks, except induced abortion. One hundred and seventeen controls were produced at random in the same period and the same hospital. The control group were defined as the eligible woman who deliver after 37 weeks of gestation, excluding the woman who deliver after gestation age 42 weeks. A case-control study was adopted with group comparison. After 55 suspected factors were analyzed with Chi-square test, seventeen risk factors for premature were revealed. Then with a multiple logistic regression, we obtained the primary risk factors for premature and calculated the etiological fraction of each risk factor .The cases that were inquiried twice showed good consistency via McNumar chi-square test. RESULTS: The seventeen risk factors for premature were gotten via single factor analyses, including pregnant woman age, poor economic status, more than 3 abortions, short maternal school education, maternal anemia, pregnancy induced hypertension, maternal heart disease, negative life events, previous preterm delivery, exposed to video display terminals, exposed to toxicant during gestation, the first obstetrical examination after gestational age 12 weeks, the frequency of obstetrical examination, exposed to noises during gestation, phone with mobile telephone longer than 5 minters everyday during gestation, maternal familial hypertension, and twin pregnancy.A multiple logistic regression model found the following factors to be independently correlated with the occurrence of preterm delivery: exposed to video display terminals more than 2.5 hours everyday during gestation (OR= 5.1, 95%CI =1.7-15.4) ,exposed to toxicantduring gestation (OR= 136.7, 95%CI =9.9-1889.6) negative life events (OR=46.1, 95%CI =2.7-771.4) .pregnancy induced hypertension (OR=4.7, 95%CI=1.1- 19.2) .previous preterm delivery (OR=159.5, 95%CI =2.5-10205.8), and their etiological fraction were 7%, 28%, 8%, 29%, 11%, respectively.Thirty women selected at random from 1071 pregnancy women were surveyed by a clinical doctor. The five risk factors were compared via McNumar chi-square test and we got consistency from 97 percent to 100 percent.CONCLUSION: Taking into account all these factors, we could get conclusion that main risk factor of premature were negative life events, pregnancy induced hypertension, previous preterm delivery, exposed to toxicant during gestation, exposed to video display terminators.Seven percent of preterm delivery resulted from exposure to video display terminators during gestation; 28 percent of preterm delivery from exposure to toxicant during gestation; 8 percent from negative life events; 29 percent from pregnancy induced hypertension; and 11 percent from previous preterm delivery. In addition, the good consistency in repeated measurement showed that questi更多还原