【作者】 刘娟；

【导师】 陈友国；

【作者基本信息】 苏州大学 ， 妇产科， 2014， 硕士

【摘要】 目的：研究妊娠期生殖道感染的特征，探讨生殖道感染及其干预措施与孕产妇围产结局的关系，为妊娠期生殖道感染的防治提供依据，提高新生儿出生质量。方法：选取2012年3月～2013年2月盐城市妇幼保健院妇产科接诊的孕6-36周的妊娠期妇女进行细菌、假丝酵母菌、滴虫、衣原体、支原体、淋球菌等生殖道感染性疾病的检查。应用SPSS17.0统计学软件进行统计分析，分析不同孕周、不同年龄孕妇之间生殖道感染的类型及分布特征。结合孕妇孕周及自主要求将孕妇分为治疗组和非治疗组，治疗者根据检查结果针对性的进行抗感染治疗，记录干预治疗措施及治疗效果与安全性，非治疗组不予以处理。跟踪所有入选孕妇的围产结局，探讨分析生殖道感染、不同感染类型、不同干预措施与围产结局之间的关系。结果：1.生殖道感染特征本研究中共1863例孕妇接受生殖道感染性疾病的检查。检查结果得出，未感染者1078例，占57.86%，存在生殖道感染者共785例，占42.14%。感染组和未感染组在年龄、孕次、流产次数方面的比较均无显著差异，无统计学意义。细菌性阴道病、滴虫、支原体、衣原体、假丝酵母菌、淋球菌、β-溶血性链球菌感染的发生机率分别为11%、2.31%、8.91%、4.03%、9.34%、1.45%、5.10%。感染者中感染类型分布如下：细菌性阴道病、滴虫、支原体、衣原体、假丝酵母菌、淋球菌、β-溶血性链球菌感染的例数分别为205（26.11%）、43（5.48%）、166（21.15%）、75（9.55%）、174（22.17%）、27（3.44%）、95（12.10%）。2.不同孕期生殖道感染分布特征孕早期感染者297例，占37.83%；孕中期感染者250例，占31.85%；孕晚期238例，占30.32%。孕早期感染以细菌性阴道病、假丝酵母菌及支原体感染为主；细菌性阴道病感染在各孕期感染中占比最高；β-溶血性链球菌感染主要出现在孕晚期。3.干预措施及疗效本研究中785例感染者采取治疗者439例（治疗组），未采取治疗者346例（非治疗组）。治疗组中，孕早期151例，占感染者的19.24%；孕中期146例，占18.60%；孕晚期142例，占18.09%。非治疗组中，孕早期146例，占18.60%；孕中期104例，占13.25%；孕晚期96例，占12.23%。治疗组与非治疗组在各孕期的分布方面无显著差异，具有可比性。治疗组中细菌感染者112例，滴虫性阴道炎25例，支原体感染者85例，衣原体感染者29例，外阴阴道假丝酵母菌166例，淋球菌22例。两组在生殖道感染类型方面也无显著性差异，具有可比性。治疗组经过针对性的精心治疗后，治愈209例（47.61%），显效157例（35.76%），有效52例（11.85%），无效21例（4.78%），总的治疗有效率（治愈率+显效率）为83.37%。4.围产结局本组1863例研究病例中，共有562例出现不良围产结局。按感染特征分类，261例出现在未感染组，不良结局的发生机率为24.21%（261/1078），301例出现在感染组，发生机率为38.34%（301/785），感染组不良结局的发生率显著高于未感染组，两者具有统计学差异（X2=43.065，P<0.05）；按感染组孕产妇是否采取干预措施分类，治疗组132例出现不良围产结局，发生机率为30.07%（132/439），非治疗组169例出现不良围产结局，发生机率为48.84%（169/346），治疗组不良围产结局的发生率显著低于非治疗组，差异具有统计学意义（X2=28.853，P<0.05）。结论：1.妊娠期生殖道感染性疾病的感染率为42.14%，其中细菌性感染的发生率最高，达26.11%。2.感染组和未感染组在年龄、孕次、流产次数方面的比较均无显著差异。3.妊娠期生殖道感染可发生在各个孕期，各孕期总的感染率无差异，但生殖道感染的类型有所不同，孕早期感染以细菌性阴道病、假丝酵母菌感染及支原体感染为主，细菌性阴道病感染在各孕期感染中占比最高，β-溶血性链球菌感染主要出现在孕晚期。4.妊娠期生殖道感染可得到良好的治疗效果，总的治疗有效率为83.37%。5.妊娠期不良结局的发生机率为30.17%。6.妊娠期生殖道感染者发生不良结局的机率（38.34%）显著高于未感染者（24.21%）。7.妊娠期生殖道感染采取干预措施者发生不良结局的机率（30.07%）显著低于未采取干预措施者（48.84%）。更多还原

【Abstract】 Objective:To study the characteristics of pregnancy reproductive tract infection, and investigatethe relationship between reproductive tract infection and its intervention measures and thepregnancy outcome, so as to provide experience for the prevention and control ofpregnancy reproductive tract infections, promote maternal and child healthy, and improvethe quality of birth.Methods:Selected sevral pregnancy women about6-36weeks pregnant from March2012toFebruary2013in Yancheng Maternal and Child Care Service Centre, who were given aseries examination, including bacterial infection examination, candida, trichomoniasis,chlamydia, mycoplasma, neisseria gonorrhoeae genital tract infectious diseases. UsingSPSS17.0statistical software for statistical analysis, analysis on the types and distributioncharacteristics of reproductive tract infections among different pregnant time and differentage. According to the pregnant time and their requestments, they were divided into twogroups, treatment group and non-treatment group. Treatment group were givenanti-infection treatment according to the check results, the intervention treatment measuresand its treatment effect and safety would be recorded. Non-treatment group were not givenany treatments. Track the pregnancy outcome of all selected pregnant women,investigation the relationship of reproductive tract infection, different infection types andthe pregnancy outcome. Results:1.The characteristics of pregnancy reproductive tract infectionIn this study,1863cases were given the infection examination, the results shows that1078cases were no infection (non-infection group), accounting for57.86%, and785caseswere reproductive tract infection(infection group), accounting for42.14%. There were nosignificant difference of age, pregnant times, abortion times between infected group andnon-infected group. There’s not statistically significant.The incidence of bacterial vaginal disease, trichomoniasis, mycoplasma, chlamydia,candida, neisseria gonorrhoeae, beta hemolytic streptococcus infection was11%、2.31%、8.91%、4.03%、9.34%、1.45%、5.10%. The infected distribution was that bacterial vaginaldisease, trichomoniasis, mycoplasma, chlamydia, candida, neisseria gonorrhoeae, betahemolytic streptococcus infection, their proportion of total infected diseases were205(26.11%)、43(5.48%)、166(21.15%)、75(9.55%)、174(22.17%)、27(3.44%)、95(12.10%).2. The characteristics of pregnancy reproductive tract infection in different pregnancytimePregnant early infection were297cases, accounting for37.83%; Mid pregnancypatients were250cases, accounting for31.85%; Late pregnancy were238cases,accounting for30.32%. Early pregnancy infection is given priority to bacterial vaginaldisease, candida and Chlamydia infection. The incidence of bacterial vaginal disease inpregnancy is the highest among pregnancy time. Beta hemolytic streptococcus infectionmainly occours in late pregnancy.3. Intervention measures and curative effectIn this study, among785cases of patients,439cases were given treatment astreatment group,346cases without taking the healer as non-treatment group. In treatmentgroup, there were151cases in early pregnancy accounting for19.24%,146cases in midpregnancy accounting for18.60%,142cases in last pregnancy accounting for18.09%. Innon-treatment group, there were146cases in early pregnancy accounting for18.60%,104cases in mid pregnancy accounting for13.25%,96cases in last pregnancy accounting for 12.23%. There was no significant difference between treatment group and non-treatmentgroup, which are comparable. Bacterial infection in the treatment group112cases,25casesof trichomonas vaginitis, mycoplasma infection in85cases, chlamydia infection29cases,vulva vagina candida166cases, neisseria gonorrhoeae22cases. There was no significantdifference in the characteristics of pregnancy reproductive tract infection between thesetwo groups. After careful treatment,209cases in the treatment group was cured (47.61%),157cases were markedly improved (35.76%),52cases were effective (11.85%),21caseswere invalid (4.78%), the general treatment effective rate was83.37%.4.Perinatal outcomeIn these1863cases,562cases had bad perinatal outcome, according to the infectioncharacteristics classified,261cases appear in the non-infected group, incidence was24.21%,301cases appear in the infection group, incidence of38.34%. There wassignificant difference between the two groups（X2=43.065, P<0.05）. According to theintervention measures classified,132cases appear in the treatment group, incidence was30.07%,169cases appear in the non-treatment group, incidence of48.84%. There wassignificant difference between the two groups（X2=28.853, P<0.05）.Conclusion:1. The rate of gestational genital tract infectious disease infection was42.14%, theincidence of bacterial infection is the highest, which is up to26.11%.2. There were no significant difference of age, pregnant times, abortion times betweeninfected group and non-infected group.3. The reproductive tract infection occurs in any pregnancy time, and there was noobvious difference among each pregnancy time, however the characteristics of pregnancyreproductive tract infection in different pregnancy time are different. Early pregnancyinfection is given priority to with bacterial vaginal disease and candida infection, theincidence of bacterial vaginal disease in Mid pregnancy is the lowest among pregnancytime. Beta hemolytic streptococcus infection mainly occours in late pregnancy.4. Reproductive tract infection during pregnancy could get good treatment effect, the total treatment effective rate was83.37%.5. The probability of the occurrence of adverse outcome during pregnancy was30.17%.6. The probability of adverse outcome of reproductive tract infections is significantlyhigher than those non-infected.7. The probability of the occurrence of adverse outcome in treatment group issignificantly lower than that in non-treatment group.更多还原