早发型与晚发型重度子痫前期的临床分析
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摘要
目的:比较早发型和晚发型重度子痫前期母体并发症的发病情况、终止妊娠方式和对围产儿结局的影响;探讨早发型重度子痫前期患者期待治疗延长孕龄与围产儿预后的关系。
方法:回顾性分析2007年4月-2008年3月在淄博市妇幼保健医院住院分娩病例,其中重度子痫前期147例作为研究对象。根据发病孕周分为两组即早发型重度子痫前期为A组≤34周,共51例,晚发型重度子痫前期为B组＞34周,共96例。A组又按是否接受期待治疗,将其分为2组,A_1组患者入院后病情危重,或给予积极治疗无明显好转,48小时内终止妊娠者;A_2组患者病情稳定,入院后进行期待治疗。期待治疗组依据病情需要给予解痉、降压、营养支持、促胎肺成熟治疗及改善微循环,同时进行母胎监测,根据病情、孕周、母胎情况选择适当时机和方式终止妊娠,期待治疗3-25天。
结果:1.早发型组进行系统产前检查者少于晚发型组,有统计学意义(P＜0.05)。A、B两组患者并发症发生情况以肝、肾功能损害、低蛋白血症、胎盘早剥、HELLP综合征、子痫的发生较常见。除子痫外,两组患者比较,差异均有统计学意义。在早发型组中A_1、A_2两组患者母体并发症发生率比较差异无统计学意义(P＞0.05)。
2.A、B两组患者围产儿结局比较,早发型组小于胎龄儿(SGA)发生率、围产儿死亡率、NICU入住率明显高于晚发型组(P＜0.01),早发型组的新生儿窒息率较晚发型组高(P＜0.05)。死胎的发生率无统计学意义(P＞0.05)。在早发型组中A_1、A_2两组患者SGA发生率、新生儿窒息、NICU入住率相比较无统计学意义(P＞0.05),而围产儿死亡率明显降低(P＜0.05)。两组入住NICU时间比较明显降低(P＜0.05)。
3.A、B两组患者分娩方式均以剖宫产为主,相比较差异有统计学意义(P＜0.05)。早发型组治疗性引产6例,均因严重母儿并发症放弃胎儿,晚发型组为0。差异有显著性意义(P≤0.01)。
结论:1.早发型重度子痫前期与晚发型相比,起病时间早,程度重,易伴发多种并发症。在围产儿结局上,早发型重度子痫前期更易发生SGA、胎儿窘迫、新生儿窒息、围产儿死亡。
2.对早发型子痫前期病例通过严格选择适当期待治疗是可行的,在进行严密母胎监护的情况下,延长孕周能获得较好的围产儿结局。而母体并发症无明显增加。适时终止妊娠是关键。终止妊娠的方式首选剖宫产。麻醉方式常选择持续硬膜外麻醉或腰麻加持续硬膜外麻醉,也证明了手术和麻醉的安全性。
3.重度子痫前期的防治重点在于预防,进行定期的产前检查能及早发现子痫前期发生,避免严重并发症发生,做好孕妇的产前保健工作非常重要。
Objective To analyze the characteristics of early and late onset severe preeclampsia involving maternal major complications,the method of pregnancy termination and perinatal outcomes;To evaluate perinatal outcomess of expectant management of early onset severe preeclampsia.
Methods One hundred and forty-severn cases meeting the criteria of severe preeclampsia were enrolled in this study,By logistic analyse method in zibo maternal and infant health care hospital in April 2007 to March 2008.Patients were divided into two groups:group A(n=51) with those onset≤34 weeks of gestation and group B(n=96) with onset＞34 weeks of gestation.The clinical data,pattern of organ damage,complications,and maternal and perinatal outcomes were compared of the two groups.Early onset group were divided into two groups by accepetting exceptant management or not as group A_1 (n=13) and group A_2(n=38) to compare the maternal major complications and perinatal outcomes.
Results There were less gravida in early onset group than in late onset group who had standard antenatal care(P＜0.05);There were significant differences between group A and group B in gestationa weeks of onset,systolic pressure, diastolic pressure,gestationa weeks of termination and the days of management(P＜0.01);The incidence of maternal major complications including hypoproteinemia,hepatic dysfunction,renal dysfunction,placental abruption,HELLP syndrome were different between group A and B;and the incidence of SGA,perinatal mortality and admission to NICU were also different between group A and group B(P＜0.01);There were no significant differences in the incidence of maternal major complications and SGA, neonatal asphyxia and admission to NICU between group A_1 and group A_2 (P＞0.05).But significant differences in favor of expectant management were noted in perinatal mortality and time for NICU(P＜0.05);Cesarean section was a main method of pregnancy termination to chooce for all groups.
Conclusion Early onset severe preeclampsia is easy to have many kinds of complications,affect maternity and perinates seriously.Expectant management is feasible and effective in early onset severe preeclampsia,In the balance of maternal-fetal condition,expectant management can prolong gestation age and get better prenatal prognosis.During the expectant management,the situation of maternity and perinates should be closely monitored,and cesarean section in the first choice.There was important significance to strengthen circumnatal period health protection,It could reduce the morbility of preeclampsia and harmful effects.
方法:回顾性分析2007年4月-2008年3月在淄博市妇幼保健医院住院分娩病例,其中重度子痫前期147例作为研究对象。根据发病孕周分为两组即早发型重度子痫前期为A组≤34周,共51例,晚发型重度子痫前期为B组＞34周,共96例。A组又按是否接受期待治疗,将其分为2组,A_1组患者入院后病情危重,或给予积极治疗无明显好转,48小时内终止妊娠者;A_2组患者病情稳定,入院后进行期待治疗。期待治疗组依据病情需要给予解痉、降压、营养支持、促胎肺成熟治疗及改善微循环,同时进行母胎监测,根据病情、孕周、母胎情况选择适当时机和方式终止妊娠,期待治疗3-25天。
结果:1.早发型组进行系统产前检查者少于晚发型组,有统计学意义(P＜0.05)。A、B两组患者并发症发生情况以肝、肾功能损害、低蛋白血症、胎盘早剥、HELLP综合征、子痫的发生较常见。除子痫外,两组患者比较,差异均有统计学意义。在早发型组中A_1、A_2两组患者母体并发症发生率比较差异无统计学意义(P＞0.05)。
2.A、B两组患者围产儿结局比较,早发型组小于胎龄儿(SGA)发生率、围产儿死亡率、NICU入住率明显高于晚发型组(P＜0.01),早发型组的新生儿窒息率较晚发型组高(P＜0.05)。死胎的发生率无统计学意义(P＞0.05)。在早发型组中A_1、A_2两组患者SGA发生率、新生儿窒息、NICU入住率相比较无统计学意义(P＞0.05),而围产儿死亡率明显降低(P＜0.05)。两组入住NICU时间比较明显降低(P＜0.05)。
3.A、B两组患者分娩方式均以剖宫产为主,相比较差异有统计学意义(P＜0.05)。早发型组治疗性引产6例,均因严重母儿并发症放弃胎儿,晚发型组为0。差异有显著性意义(P≤0.01)。
结论:1.早发型重度子痫前期与晚发型相比,起病时间早,程度重,易伴发多种并发症。在围产儿结局上,早发型重度子痫前期更易发生SGA、胎儿窘迫、新生儿窒息、围产儿死亡。
2.对早发型子痫前期病例通过严格选择适当期待治疗是可行的,在进行严密母胎监护的情况下,延长孕周能获得较好的围产儿结局。而母体并发症无明显增加。适时终止妊娠是关键。终止妊娠的方式首选剖宫产。麻醉方式常选择持续硬膜外麻醉或腰麻加持续硬膜外麻醉,也证明了手术和麻醉的安全性。
3.重度子痫前期的防治重点在于预防,进行定期的产前检查能及早发现子痫前期发生,避免严重并发症发生,做好孕妇的产前保健工作非常重要。
Objective To analyze the characteristics of early and late onset severe preeclampsia involving maternal major complications,the method of pregnancy termination and perinatal outcomes;To evaluate perinatal outcomess of expectant management of early onset severe preeclampsia.
Methods One hundred and forty-severn cases meeting the criteria of severe preeclampsia were enrolled in this study,By logistic analyse method in zibo maternal and infant health care hospital in April 2007 to March 2008.Patients were divided into two groups:group A(n=51) with those onset≤34 weeks of gestation and group B(n=96) with onset＞34 weeks of gestation.The clinical data,pattern of organ damage,complications,and maternal and perinatal outcomes were compared of the two groups.Early onset group were divided into two groups by accepetting exceptant management or not as group A_1 (n=13) and group A_2(n=38) to compare the maternal major complications and perinatal outcomes.
Results There were less gravida in early onset group than in late onset group who had standard antenatal care(P＜0.05);There were significant differences between group A and group B in gestationa weeks of onset,systolic pressure, diastolic pressure,gestationa weeks of termination and the days of management(P＜0.01);The incidence of maternal major complications including hypoproteinemia,hepatic dysfunction,renal dysfunction,placental abruption,HELLP syndrome were different between group A and B;and the incidence of SGA,perinatal mortality and admission to NICU were also different between group A and group B(P＜0.01);There were no significant differences in the incidence of maternal major complications and SGA, neonatal asphyxia and admission to NICU between group A_1 and group A_2 (P＞0.05).But significant differences in favor of expectant management were noted in perinatal mortality and time for NICU(P＜0.05);Cesarean section was a main method of pregnancy termination to chooce for all groups.
Conclusion Early onset severe preeclampsia is easy to have many kinds of complications,affect maternity and perinates seriously.Expectant management is feasible and effective in early onset severe preeclampsia,In the balance of maternal-fetal condition,expectant management can prolong gestation age and get better prenatal prognosis.During the expectant management,the situation of maternity and perinates should be closely monitored,and cesarean section in the first choice.There was important significance to strengthen circumnatal period health protection,It could reduce the morbility of preeclampsia and harmful effects.
引文
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