重度子痫前期终止妊娠时机及方式的选择  

The selection of timing and methods of pregnancy termination in sever pre - eclampsia

作　　者：谢小球 黄惠华 舒晓娅 

机构地区：[1]湖南省荣军医院妇产科,湖南长沙410119

出　　处：《中国民康医学》2009年第19期2371-2373,共3页Medical Journal of Chinese People’s Health

摘　　要：目的:探讨重度子痫前期终止妊娠的时机与方式对母婴结局的影响。方法:回顾性分析本院1997年12月至2008年1月收治的116例重度子痫前期患者(发病孕周为28～35+6周的临床资料,按发病孕周将其分成4组:28～29+6周,30～31+6周,32～33+6周和34～35+6周,分析期待治疗与积极治疗对妊娠结局的影响,并观察不同妊娠终止方式的围产儿窒息率与死亡率。结果:①4组的期待治疗平均延长孕龄分别为(4.2±1.5)d、(11.9±6.1)d、(9.6±5.1)d、和(7.2±3.8)d,4组间比较,差异有统计学意义(P<0.05);②发病孕周在28-33+6周的期待治疗组的新生儿窒息率低于积极治疗组(P<0.05),期待治疗组的新生儿体重明显大于积极治疗组(P<0.05);而34～35+6周期待治疗组的新生儿窒息率和新生儿体重与积极治疗比较差异均无统计学意义(P>0.05);③多因素Logistic回归分析显示在28～33+6周期待治疗可以降低新生儿窒息率且无孕妇死亡、加重脏器损害及后遗症的发生。而在34～35+6周期待治疗并未改善母婴结局;④本组病例中剖宫产88例(75.9%),其中21例发生窒息,3例死亡,窒息率和死亡率分别为23.9%、3.4%;阴道产28例(24.1%),其中13例发生窒息,5例死亡,窒息率和死亡率分别为46.4%、17.9%。各组间差异均有统计学意义(P<0.05)。结论:对重度子痫前期患者进行适当的期待治疗,有利于改善妊娠结局,是治疗重度子痫前期极其有效的重要手段;终止妊娠的方式首选剖宫产。Objective: To explore the effect of timing and methods of pregnancy termination on maternal and fetal outcomes in severe pre - eclampsia.Methods: To retrospectively analyze the clinical data of 116 cases with severe pre - eclampsia at 28 - 35+6 gestation week admitted to our hospital from December of 1997 to January of 2008.They were divided into four groups according to the onset time of the disease:28 -29+6week,30 -31+6week,32 -33+6week and 34 -35+6week, the effect of expectant management and aggressive management on pregnancy outcomes were analyzsed the rates of neonatal asphyxia, preinatal mortality of different pregnancy termination were observed.Results: ① The average pregnancy prolongation in four groups were (4.2 ± 1.5) , (11.9 ±6.1) , (9.6 ± 5.1) ,and(7.2 ±3.8) days respectively.The difference between the four groups were significant (P <0.05).②In group 28 -33+6 week, the rate of neonatal asphyxia with expectant managent was lower than those with aggressive management (P < 0.05) and the birth weight in the expectant management was significantly higher than that in aggressive management (P < 0.05).But in34 - 35+6 week group,the difference of neonatal asphyxia rate and birth weight of expectant and aggressive management cluld innored(P > 0.05).③ The logistic regression showed tha expectant management could decrease the rate of neonatal asphyxia and with no death and sequela in gravid found in group 28 -33+6 week.But in 34 - 35+6week group the expectant management did not improve the maternal and fetal lutcomes.④88 cases(75.9%) were terminated by caesarean section,in those cases 21 were severely asphyxiated and 3 died,the asphyxia rate and mortality rate were 23.9% and 3.4% respectively.28 cases(24.1%) were ended by vagina delivery,in those cases 13 were asphyxiated and 5 died, the asphyxia rate and mortality rate were 46.4% and 17.9% respectively.The difference between the groups were significant (P < 0.05) .Conclusions:Appropriate expectant management of severe pre - eclampsia benefits the pre

关 键 词：重度子痫前期 终止妊娠时机及方式 妊娠结局 

分 类 号：R714.245[医药卫生—妇产科学]