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对有晚期早产风险的孕妇产前给予倍他米松
Antenatal Betamethasone for Women at Risk for Late Preterm Delivery


Cynthia Gyamfi-Bannerman ... 妇产科和儿科 • 2016.04.07

糖皮质激素用于晚期早产也改善预后

 

王欣

首都医科大学附属北京妇产医院

 

早产是新生儿死亡的最主要原因,也是产科医师一直关注的问题。关注点主要包括两方面:一方面是早产的预防,另一方面则是早产并发症的预防和治疗。

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摘要


背景

与足月儿(孕37周或之后)相比,孕34~36周(晚期早产)出生的早产儿发生不良呼吸系统事件等结局的风险较高。对于有晚期早产风险的孕妇,给予倍他米松能否降低新生儿患病风险?目前答案尚不清楚。

 

方法

本研究是一项多中心、随机临床试验,纳入晚期早产(孕36周6日前生产)风险较高的单胎妊娠孕妇作为研究对象,其孕期为孕34周0日至孕36周5日。我们将参与者随机分配,分别注射两次倍他米松或安慰剂,注射间隔24小时。主要结局为新生儿生后72小时内接受的综合治疗(包括使用持续气道正压通气或高流量鼻导管吸氧2小时或以上、吸入氧比例[fraction]不低于0.30下补氧≥4小时、体外膜式氧合、机械通气)、死胎和新生儿产后72小时内死亡。

 

结果

倍他米松组165/1,427例(11.6%)新生儿和安慰剂组202/1,400例(14.4%)新生儿出现主要结局事件(倍他米松组的相对风险[RR]为0.80,95%置信区间[CI]为0.66~0.97,P=0.02)。倍他米松组中,严重呼吸系统并发症、新生儿短暂呼吸急促、使用表面活性剂以及支气管肺发育不良的发生频率显著较低。两组间绒毛膜羊膜炎或新生儿败血症的发生率未见显著差异。倍他米松组中新生儿低血糖较安慰剂组常见(24.0% vs. 15.0%;RR=1.60;95% CI,1.37~1.87;P<0.001)。

 

结论

对有晚期早产风险的孕妇给予倍他米松可显著降低新生儿呼吸系统并发症的发生率(由美国国立心肺血液研究所与Eunice Kennedy Shriver国立儿童健康和人类发展研究所资助;ClinicalTrials.gov编号为NCT01222247)。





作者信息

Cynthia Gyamfi-Bannerman, M.D., Elizabeth A. Thom, Ph.D., Sean C. Blackwell, M.D., Alan T.N. Tita, M.D., Ph.D., Uma M. Reddy, M.D., M.P.H., George R. Saade, M.D., Dwight J. Rouse, M.D., David S. McKenna, M.D., Erin A.S. Clark, M.D., John M. Thorp, Jr., M.D., Edward K. Chien, M.D., Alan M. Peaceman, M.D., Ronald S. Gibbs, M.D., Geeta K. Swamy, M.D., Mary E. Norton, M.D., Brian M. Casey, M.D., Steve N. Caritis, M.D., Jorge E. Tolosa, M.D., M.S.C.E., Yoram Sorokin, M.D., J. Peter VanDorsten, M.D., and Lucky Jain, M.D. for the NICHD Maternal–Fetal Medicine Units Network*
From Columbia University, New York (C.G.-B.); the George Washington University Biostatistics Center, Washington, DC (E.A.T.); the University of Texas Health Science Center at Children’s Memorial Hermann Hospital, Houston (S.C.B.), the University of Texas Medical Branch, Galveston (G.R.S.), and the University of Texas Southwestern Medical Center, Dallas (B.M.C.) — all in Texas; the University of Alabama at Birmingham, Birmingham (A.T.N.T.); the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (U.M.R.); Brown University, Providence, RI (D.J.R.); Ohio State University, Columbus (D.S.M.), and the MetroHealth Medical Center, Case Western Reserve University, Cleveland (E.K.C.) — both in Ohio; the University of Utah Health Sciences Center, Salt Lake City (E.A.S.C.); the University of North Carolina at Chapel Hill, Chapel Hill (J.M.T.), and Duke University, Durham (G.K.S.) — both in North Carolina; Northwestern University, Chicago (A.M.P.); the University of Colorado School of Medicine, Anschutz Medical Campus, Aurora (R.S.G.); Stanford University, Stanford, CA (M.E.N.); University of Pittsburgh, Pittsburgh (S.N.C.); Oregon Health and Science University, Portland (J.E.T.); Wayne State University, Detroit (Y.S.); the Medical University of South Carolina, Charleston (J.P.V.); and Emory University, Atlanta (L.J.). Address reprint requests to Dr. Gyamfi-Bannerman at the Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 W. 168th St., PH-16, New York, NY 10032, or at cg2231@cumc.columbia.edu. *A complete list of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal–Fetal Medicine Units Network is provided in the Supplementary Appendix, available at NEJM.org.

 

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