妊娠中晚期重型肝炎对孕妇及胎儿预后的影响与防治  

The impact of severe viral hepatitis on prognosis of both the pregnant women and the fetus during metaphase and late pregnancy along with its prevention and treatment

作　　者：陈幼明[1] 朱建芸[1] 麦丽[1] 范建辉[2] 江元森[1] 

机构地区：[1]中山大学附属第三医院感染科,广东广州510630 [2]中山大学附属第三医院妇产科

出　　处：《中国妇幼保健》2008年第30期4253-4255,共3页Maternal and Child Health Care of China

摘　　要：目的:探讨妊娠中晚期重型病毒性肝炎对孕妇及胎儿预后影响及防治措施。方法:回顾性分析54例妊娠中晚期重型病毒性肝炎患者的临床及实验室资料。结果:HBV相关、HEV相关、重叠感染率分别为66.67%、25.93%、29.63%;总病死率为68.52%,急性、亚急性及慢性妊娠期重肝的病死率分别为85.71%、80.00%、56.67%,中晚期妊娠患者病死率分别为68.75%、68.42%,各组间比较无统计学差异(P>0.05);存活组和死亡组在凝血酶原时间(PT)、血清总胆固醇(CHOL)及肝脏体积缩小等比较有统计学差异(P<0.05),并发症发生频率排位:肝性脑病、感染、肝肾综合征、DIC、产后大出血,并发症数量增多则病死率升高;胎儿总死亡率48.15%,其中HBV感染相关的死亡率55.56%。结论:本组病例以HBV、HEV感染最常见,孕产妇及胎儿死亡率高;妊娠中晚期重型病毒性肝炎孕妇转归与PT、CHOL、肝脏体积大小、并发症的数量有关,胎儿预后可能与HBV感染及高胆红素血症有关;避免妊娠中晚期重型病毒性肝炎发生的关键在于早期预防和治疗肝炎病毒感染。Objective： To discuss the impact of severe viral hepatitis on prognosis of both the pregnant women and the fetus during metaphase and late pregnancy along with its prevention and treatment. Methods： To analyze clinical manifestations and laboratory findings of 54 eases of severe viral hepatitis during metaphase and late pregnancy retrospectively. Results： The prognosis was related to HBV and HEV infection, and the co - infection rate were 66. 67%, 25.93% and 29. 63% respectively, and the total mortality rate was 68. 52%. The mor- tality rates of acute, sub - acute and chronic severe viral hepatitis during pregnancy were 85.71%, 80. 00% and 56. 67% respectively. The mortality rates of severe viral hepatitis cases during metaphase and late pregnancy were 68.75% and 68.42%, and there was no significant difference between the two groups （P 〉 0. 05 ） . The originating rate of complications was as follows： hepatic encephalopathy, infection, hepatorenal syndrome, DIC and pest -partum massive haemorrhage, More complications induced more mortality rates. The total mortality rate of fetus was 48. 15%, and 55.56% of which is related to HBV infection. Conclusion： HBV and HEV infection are most common in this group, and the mortality rate of both pregnant women and fetus is high. The prognosis of severe viral hepatitis during metaphase and late pregnancy is related to PT, CHOL, the size of the liver and the number of complications. And the prognosis of fetus is related to HBV infection and hyperbilirubinemia. Thus the key to preventing severe viral hepatitis during metaphase and late pregnancy lies in the prevention and treatment of hepatitis viral infection in the early stage.

关 键 词：妊娠 重型病毒性肝炎 孕妇 胎儿 

分 类 号：R714.251[医药卫生—妇产科学]