重度子痫前期并发腹水的临床特点和终止妊娠时机的探讨  

Clinical characteristics and timing of delivery in women with severe preeclampsia complicated with ascites

作　　者：倪镌[1] 黄艳君[1] 吴敏[1] 刘小利[1] 周洁[1] 黄引平[1] 

机构地区：[1]温州医学院附属第一医院妇产科,325000

出　　处：《中华围产医学杂志》2009年第1期10-14,共5页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨重度子痫前期并发腹水的临床特点及终止妊娠时机。方法对179例重度子痫前期患者的临床资料进行回顾性分析，根据有无并发腹水分为腹水组（32例）和非腹水组（147例），分析两组孕妇一般情况、分娩方式、合并症／并发症（包括子痫、HELLP综合征、肝肾功能不全、心功能不全、低蛋白血症、胎盘早剥、产后出血、产褥感染）。收集两组围产儿（腹水组38例，无腹水组157例）的临床资料，分别比较两组间和腹水组内胎龄〈32周，32周～，34周～，36周～组的小于胎龄儿（small for gestational age，SGA）的发生率和死亡率。结果（1）腹水组平均入院孕周和平均分娩孕周均早于无腹水组[入院：（32．5±2．1）周和（36．1±3．5）周，分娩：（34．1±2．3）周和（37．2±1．5）周，P均〈0．05）。腹水组系统产前检查率低于无腹水组（25．0％和53．7％，P〈0．05）。腹水组低蛋白血症（100．0％和47．0％）、肝肾功能不全（31．2％和8．2％）、HELLP综合征（9．4％和2．0％）、产后出血发生率（18．8％和2．0％）均高于无腹水组（P均〈0．05）。（2）腹水组不同胎龄围产儿SGA发生率均高于同胎龄无腹水组，但仅胎龄〉36周组差异有统计学意义（7／9和30．2％，P〈0．05）。腹水组胎龄〈32周和32周～围产儿死亡率高于无腹水组（〈32周：69．2％和19．2％，P〈0．05；32周～：2／7和0，P〈0．05）。（3）腹水组内围产儿胎龄〈32周时围产儿死亡率较其他胎龄组高，胎龄〉36周围产儿SGA发生率最高（P〈0．05）。结论重度子痫前期并发腹水发病早，并发症多，母婴预后不佳。腹水是重度子痫前期的一个危险信号，应该引起产科医生的高度重视。对于重度子痫前期并发腹水围产儿，32-36周可能为终止妊娠的良好时机。Objective To investigate the clinical characteristics and the optimal time of delivery in pregnant women with severe preeclampsia complicated with ascites. Methods A retrospective study was conducted on 179 severe preeclampsia mothers and their 195 neonates, presented in the First Affiliated Hospital of Wenzhou Medical College from Jan. 2003 to Dec. 2005, who were divided into two groups： 32 complicated with ascites （aseites group） and 147 without （non-ascites group）. The general conditions, mode of delivery and complications including eclampsia, hemolysis, elevated serum level of liver enzymes, and low platelets （HELLP syndrome）, liver failure, renal failure, heart failure, hypoproteinemia, placental abruption, postpartum hemorrhage and puerperal infection, were also analyzed. Clinical data of all infants （38 from aseites group and 157 from non-aseites group） were analyzed. The incidence and mortality rate of small for gestational age （SGA） in both group within the same gestational age group and those between different gestational age groups in the ascites group were compared. Results （1） The average gestations at admission and delivery in the ascites group were earlier than the other [admission： （32.5±2.1）weeks vs （36.1±3.5）weeks; delivery： （34.1±2.3） weeks vs （37.2±1.5）weeks, P〈0.05]. The rate of systemic antenatal care in the ascites group was lower than that of the non-ascites group （25.0% vs 53.7%, P〈0. 05）. More complications were found in the ascites group than in the non-ascites group （hypoproteinemia： 100.0%vs 47.0% ;liver and renal failure： 31.2% vs 8.2%; HELLP syndrome： 9.4% vs 2.0%; postpartum hemorrhage： 18.8% vs 2.0% ; all P〈0.05）. （2） The incidence of SGA in the ascites group was all higher than that in the non-ascites group, however, significant differences was only found between the two groups at 〉36 weeks （7/9 vs 30.2%, P〈0.05）. The perinatal mortality rates of SGA in the ascites group at 〈32 weeks and 32-34 w

关 键 词：先兆子痫 腹水 回顾性研究 

分 类 号：R714[医药卫生—妇产科学]