妊娠合并慢性再生障碍性贫血患者并发子痫前期的危险因素分析  

Analysis of risk factors for preeclampsia in pregnancies complicated with chronic aplastic anemia

作　　者：张超[1] 尹璐瑶[1] 梁梅英[1] 王山米[1] 张晓红[1] 王建六[1] 

机构地区：[1]北京大学人民医院产科, 100044

出　　处：《中华妇产科杂志》2012年第6期422-426,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的通过分析妊娠合并慢性再生障碍性贫血（慢性再障）患者的产科处理及妊娠结局，探讨其并发子痫前期的危险因素。方法对北京大学人民医院2002年5月至2011年2月收治的41例妊娠合并慢性再障患者的临床资料中的产科处理、实验室检测结果及妊娠结局进行回顾性分析，采用多因素回归分析方法对妊娠合并慢性再障患者的妊娠并发症子痫前期的危险因素进行分析。结果（1）41例妊娠合并慢性再障患者孕前诊断明确28例（28／41，68％），孕期诊断13例（13／41，32％）；11例（11／41，27％）患者于妊娠晚期出现轻微出血倾向，7例重型再障患者均有出血倾向。（2）41例妊娠合并慢性再障患者的中位白细胞计数5．0x10’／L，中位血红蛋白含量66．0∥L，中位血小板计数12．0×10。／L。（3）产科处理包括严密的病情评估及随诊复查，适时输血支持治疗，及时发现妊娠并发症，适时终止妊娠。其中21例患者孕期接受输血支持治疗，10例（10／41，24％）并发子痫前期（均为重度子痫前期），12例（12／41，29％）发生产后出血，其中3例出血量超过1000ml，均保守治疗成功。（4）41例患者的终止妊娠中位孕周为37周，其中16例患者分娩孕周不足37周，早产率为39％（16／41），5例患者分娩孕周不足34周；2例患者分别于孕29周及30周时发生重度子痫前期，新生儿因重度窒息死亡。活产新生儿出生体质量为1500—3660g。（5）产后随访时间6个月至7年，33例患者血红蛋白含量及血小板计数减少程度均有不同程度改善，不需要依赖输血；4例患者血红蛋白含量或血小板计数减少程度无明显好转，仍需间断输血，4例患者失访。（6）对并发子痫前期的10例患者与未发生子痫前期的31例患者进行单因素分析，结果显示，两者在出血倾向、血小板计数及终止妊娠孕周方面存在显[ Abstract ] Objective To investigate the risk factors for preeclampsia （PE） in pregnancies complicated with chronic aplastic anemia （CAA） by analyzing the obstetric management and pregnancy outcome. Methods Retrospectively review the clinical data including the obstetric management, the laboratory findings and the pregnancy outcome of 41 pregnant women complicated with CAA, all of whom were hospitalized in Peking University People＇s Hospital from May 2002 to February 2011. Multiple logistic regression was used to explore the risk factors associated with PE. Results （ 1 ） Twenty-eight patients were diagnosed before conception while 13 were diagnosed during gestation. Eleven patients including all the 7 who were categorized as severe CAA presented with mild bleeding in the third trimester. （2） The medians of white blood cell counts, hemoglobin concentrations and platelet counts were 5.0 × 10^9/L, 66. 0 g/L and12. 0 × 10^9/L respectively. （3） The obstetric management consisted of strict assessment, intensive surveillance and follow-up, appropriate supportive measures, timely recognition of complications, and delivery when necessary. Twenty-one patients received supportive transfusions. Ten patients developed PE, all of whom were diagnosed as severe PE （SPE）. Twelve patients suffered postpartum hemorrhage, and 3 of them had blood loss more than 1000 ml. All were conservatively treated in success. （4） The median gestational age of delivery was 37 weeks. Sixteen cases delivered before 37 weeks and 5 delivered before 34 weeks. Two patients developed SPE at 29 weeks and 30 weeks respectively, and both of the neonates died for severe asphyxia. The birth weight of the live neonates ranged from 1500 to 3660 g. （5） The postpartum follow-up period ranged from 6 months to 7 years. Thirty-three patients got improvement without dependence on transfusions. Four achieved no remission and still needed intermittent transfusions. Four were lost in follow- up. （6） Significant differences were f

关 键 词：妊娠并发症 血液 贫血 再生障碍性 先兆子痫 妊娠结局 危险因素 

分 类 号：R714.25[医药卫生—妇产科学]