中国妇幼保健

目的 探讨地塞米松在晚期早产选择性剖宫产中的临床效果。方法 选取2022年1月—2023年3月瑞安市妇幼保健院收治的146例晚期早产选择性剖宫产患者为研究对象。根据患者意愿，分为观察组74例，对照组72例。对照组采用常规治疗，入院后接受常规护理、对症支持治疗，待产，并进行子宫下段剖宫产手术进行分娩。观察组入院待产期间采用予地塞米松肌内注射，6 mg/次，12 h/次，连续使用48 h。余处理与对照组一致。采用前瞻性研究的方法，收集患者的临床相关资料，包括：年龄、孕周、体质指数、新生儿Apgar评分、母体产后并发症(产褥感染)、新生儿并发症(新生儿呼吸窘迫综合征、湿肺、感染性肺炎、颅内出血)等并进行比较。结果 两组一般资料比较差异均无统计学意义(均P>0.05)。观察组的新生儿在出生后1 min和5 min的Apgar评分为(9.97±0.16)分和(10.00±0.00)分，对照组的新生儿在出生后1 min和5 min的Apgar评分为(9.92±0.37)分和(10.00±0.00)分，差异无统计学意义(P>0.05),表明两组间在新生儿出生后皮肤颜色、心搏速率、呼吸、肌张力及运动以及反射方面无显著差异。在并发症方面，观察组的新生儿总发病率18.91%较对照组良好(P<0.05);其中观察组新生儿湿肺9例，显著低于对照组21例(29.17%),差异有统计学意义(P<0.05);观察组发生新生儿NRDS 2例，对照组9例(12.50%),观察组新生儿感染性肺炎3例，对照组11例(15.28%),差异均有统计学意义(均P<0.05)。结论 地塞米松能显著改善晚期早产选择性剖宫产新生儿的预后，具有较好的肺功能保护作用，有利于降低新生儿湿肺、新生儿呼吸窘迫综合征、感染性肺炎的发生，并不会增加母体产褥感染等发生率，但对新生儿出生阿普加评分及颅内出血方面改善效果不明确，临床对于早产选择性剖宫产方面，仍需做好预防。

Objective To investigate the clinical effect of dexamethasone in late premature cesarean section.Methods From January 2022 to March 2023, 146 patients with late premature cesarean section were recruited as subjects in Ruian Maternity and Child Care Hospital.According to that wishes of the patient,, they were divided into observation group(74 cases) and control group(72 cases).The control group received routine treatment, including admission, routine nursing, symptomatic support treatment, waiting for delivery, and uterine segment cesarean section for delivery.During admission and waiting for delivery, the observation group received intramuscular injection of dexamethasone, 6 mg/time, every 12 hours, for 48 hours.The rest of the treatment was consistent with the control group.A prospective study was used to collect clinical data from patients, including age, gestational age, body mass index, neonatal Apgar score, maternal postpartum complications(puerperal infection), and neonatal complications(NRDS, wet lung, infectious pneumonia, intracranial hemorrhage), etc., and comparisons were made.Results The two groups were generally comparable(P>0.05).There was no significant difference in the Apgar scores between the observation group(9.97±0.16) points and the control group(9.92±0.37) points at 1 minute after birth, and between the observation group(10.00±0.00) points and the control group(10.00±0.00) points at 5 minutes after birth(P>0.05).In terms of complications, the total incidence of neonatal complications in the observation group was 18.91%, which was better than that in the control group(P<0.05).There were 9 cases of neonatal wet lung in the observation group, significantly lower than 21 cases in the control group(29.17%),the differenceis statistically significant(P<0.05).There were 2 cases of NRDS in the observation group and 9 cases in the control group(12.50%),the differenceis statistically significant(P<0.05).There were 3 cases of neonatal infectious pneumonia in the observation group and 11 cases in the control group(15.28%),the differenceis statistically significant(P<0.05).The observation group showed significantly lower incidence than the control group.There was no significant difference in the incidence of neonatal intracranial hemorrhage between the control group and the observation group(P>0.05).In terms of maternal complications, there were 2 cases of puerperal infection in the observation group and 4 cases in the control group(P>0.05), with no significant difference between them.Conclusion Dexamethasone can significantly improve the prognosis of late premature cesarean section neonates, with good pulmonary function protection effect, which is beneficial to reduce the occurrence of neonatal wet lung, NRDS, infectious pneumonia, and does not increase the incidence of maternal puerperal infection.However, it is not clear whether it can improve neonatal Apgar score and intracranial hemorrhage at birth.In clinical practice, we still need to take prevention measures for premature cesarean section.