子宫颈环扎术后未足月胎膜早破拆除环扎线的时机研究

Optimal timing of cerclage suture removal following preterm premature rupture of membranes after cervical cerclage

摘要

目的 探讨子宫颈环扎术(CC)后未足月胎膜早破(PPROM)拆除环扎线的时机。方法 选取2022年4月至2024年4月期间宁德市医院收治的86例行CC后发生PPROM的孕妇为研究对象,根据破膜后环扎线拆除时机将其分成早期组(<24h)和延期组(>24h),每组43例.比较两组妊娠结局、炎性标志物[降钙素原(PCT)、白介素-6(IL-6)、白细胞数(WBC)、C反应蛋白(CRP)]水平、新生儿Apgar评分及感染并发症。结果 早期组破膜至分娩时间间隔短于延期组,差异有统计学意义(t=9.507,P<0.05);分娩前,两组孕妇血清PCT、IL-6、CRP水平较破膜时均升高(t值介于2.338~19.971之间,P<0.05),两组孕妇WBC水平较破膜时差异无统计学意义(P>0.05);分娩前早期组孕妇PCT、IL-6水平低于延期组,差异有统计学意义(t值分别为2.304、2.156,P<0.05),两组间WBC、CRP水平比较差异无统计学意义(P>0.05);早期组新生儿Apgar评分高于延期组,差异有统计学意义(t=7.329,P<0.05);两组产后出血情况、感染并发症总发生率、新生儿体重比较差异均无统计学意义(P>0.05)。结论 在行宫颈环扎术后发生未足月胎膜早破,早期拆线可缩短破膜至分娩时间间隔,改善炎症反应,但对围产期不良结局无明显影响.

Abstract

Objective To investigate the optimal timing of cerclage suture removal in patients with premature rupture of membranes (PPROM) after cervical cerclage (CC). Methods A total of 86 pregnant women with PPROM after CC who were admitted to the affiliated Ningde Municipal Hospital of Ningde Normal University from April 2022 to April 2024 were selected as the research subjects. They were divided into the early group (<24 hours) and the delayed group (>24 hours) based on the timing of the removal of the cerclage suture after membrane rupture, with 43 cases in each group. Pregnancy outcomes, inflammatory markers [procalcitonin (PCT), interleukin-6 (IL-6), white blood cell count (WBC), C-reactive protein (CRP)] levels, neonatal Apgar score and infectious complications were compared between the two groups. Results The interval from membrane rupture to delivery was significantly shorter in the early removal group compared to the delayed removal group (t=9.507, P<0.05). Prior to delivery, both groups showed elevated serum levels of PCT, IL-6, and CRP compared to levels at membrane rupture (t-values ranging from 2.338 to 19.971, P<0.05), while no significant difference was observed in WBC levels (P>0.05). At delivery, the early removal group demonstrated significantly lower PCT and IL-6 levels than the delayed removal group (t=2.304 and 2.156, respectively, P<0.05), with no significant intergroup differences in WBC or CRP levels (P>0.05). Neonatal Apgar scores were significantly higher in the early removal group (t=7.329, P<0.05). No significant differences were found between groups regarding postpartum hemorrhage, total incidence of infectious complications, or neonatal birth weight (all P>0.05). Conclusion In patients with PPROM after CC, early cerclage suture removal can shorten the interval from membrane rupture to delivery and reduce inflammatory responses, but has no significant effect on adverse perinatal outcomes.

关键词

孕妇 / 未足月胎膜早破 / 子宫颈环扎术 / 环扎线拆除 / 时机 / 临床效果

Key words

pregnant woman / preterm premature rupture of membranes / cervical cerclage / cerclage suture removal / timing / clinical outcome

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