早发型重度子痫前期孕妇期待治疗中不良妊娠结局的危险因素分析  

Risk factors of adverse pregnancy outcomes during expectant management of early onset severe pre-eclampsia

作　　者：伍绍文[1] 吴连方[1] 王琪[1] 张为远[1] 

机构地区：[1]首都医科大学附属北京妇产医院产科,100026

出　　处：《中华妇产科杂志》2010年第3期165-169,共5页Chinese Journal of Obstetrics and Gynecology

基　　金：首都医学发展基金（2005-2011）

摘　　要：目的 探讨早发型重度子痫前期孕妇实施期待治疗过程中发生不良妊娠结局的危险因素.方法 选择2007年1月至2008年6月在首都医科大学附属北京妇产医院住院的早发型重度子痫前期并实施期待疗法的孕妇136例.按照妊娠结局分为良好结局组101例和不良结局组35例.采用回顾性分析方法,分析两组孕妇人院时的一般资料、妊娠结局、尿常规、血流动力学及血常规指标、肝肾功能,另分析不良妊娠结局的危险因素.结果 （1）一般资料：良好结局组与不良结局组孕妇入院时出现子痫前期症状的发生率（分别为35.6%及57.1%）比较,差异有统计学意义（P〈0.05）.两组孕妇年龄、孕次、孕前体质指数、入院时并发症发生率及规律产前检查率比较,差异均无统计学意义（P〉0.05）.（2）妊娠结局：良好结局组孕妇期待疗法平均天数为（6.5±8.2）d,不良结局组平均为（6.8±10.0）d,两组比较,差异无统计学意义（P〉0.05）.不良结局组孕妇主要并发症为胎盘早剥13例,心功能衰竭及肺水肿10例,溶血、肝酶升高和低血小板计数（HELLP）综合征5例,胎死宫内5例,无子痫发生.良好结局组孕妇均无以上并发症发生.（3）期待疗法中发病孕周及分娩孕周、血压及尿蛋白比较：良好结局组的发病孕周及分娩孕周[分别为（33.0±4.9）及（34.0±3.6）周]明显晚于不良结局组[分别为（31.3±3.4）及（32.1±3.0）周],收缩压及尿蛋白定量明显低于不良结局组.良好结局组中尿蛋白定性（＋＋＋）比例明显低于不良结局组.以上指标两组比较,差异均有统计学意义（P〈0.05）.（4）血流动力学及血常规：良好结局组孕妇血液黏度[（4.6±0.4）mPa·s]明显低于不良结局组,两组比较,差异有统计学意义（P〈0.05）.而心输出量、心脏指数、外周阻力及血管顺应性等指标在两组孕妇中比较,差异均无统计学意义（P〉O.05）.�Objective To identify the risk factors of adverse pregnancy outcomes in expectant management of pregnant women with early onset severe pre-eclampsia （EOSP）. Methods Totally, 136 gravidas, who were diagnosed as ESOP and received expectant management from January 2007 to June 2008 in Beijing Obstetrics and Gynecology Hospital, were selected and divided into two groups; the favorable pregnancy outcome group （control, n=101）and the adverse pregnancy outcome group （n=35）.The general clinical information, pregnancy outcomes, routine urine test, hemodynamic data, routine blood test, liver and renal function test on admission were collected and the risk factors for adverse outcomes were retrospectively analyzed.Results （1）General clinical information; more women complained of preeclamptic symptoms on admission in the adverse outcome group than in the control group （35.6% vs.57.1 %,P〈 0.05）.No significant differences was found between the two groups in the maternal age, times of previous pregnancies, prevalence of concurrent complications, pre-pregnant body mass index （BMI）,proportion of women who had regular antenatal checks（P 〉 0.05）.（2） Pregnant outcomes; the average duration of expectant management in the control group were similar to the adverse outcomes group [（6.5 ± 8.2） days vs.（6.8 ±10.0） days, P 〉 0.05].The main complications in the adverse outcome group included placental abruption （n=13）, heart failure and pulmonary edema （n=10）,hemolysis, elevated liver enzymes and low platelet syndrome （HELIP syndrome, n=5）,and no eclampsia was reported.However, none of these complications was reported from the control group.（3）Blood pressure and proteinuria; the gestation ages at the onset of EOSP and at delivery in the control group were earlier than those of the adverse outcome group [（31.3 ± 3.4） weeks vs.（33.0 ± 4.9） weeks, （32.1 ± 3.0） weeks vs.（34.0 ± 3.6） weeks, P〈 0.05],the systolic blood pressure and urinary protein and the propor

关 键 词：先兆子痫 综合疗法 妊娠结局 危险因素 红细胞计数 血小板计数 

分 类 号：R714.2[医药卫生—妇产科学]