早发型重度子痫前期患者终止妊娠时机和方式的临床探讨  

作　　者：杨华光[1] 李艳红 李怡[1] 尹国武[1] 

机构地区：[1]第四军医大学唐都医院妇产科,西安710038

出　　处：《中国综合临床》2012年第10期1103-1107,共5页Clinical Medicine of China

摘　　要：目的从妊娠结局探讨早发型重度子痫前期患者剖宫产术后的安全性及手术效果。方法回顾分析236例孕龄为28—33＋6周重度子痫前期患者的完整临床资料（实验组），并将399例孕龄在34周以上的重度子痫前期患者作为对照组。主要分析指标包括：发病孕龄、终止妊娠孕龄、孕龄延长时间、终止妊娠的方式、严重并发症发生情况、围产儿病死率和新生儿窒息率。结果实验组保守治疗时间为（13．5±1．2）d，对照组为（9．6±1．O）d，两组比较差异有统计学意义（t=3．760，P〈0．001）。剖宫产率实验组为70．8％（167／236）；对照组71．2％（284／399），两组组比较差异无统计学意义（X2=0．012，P=0．911）。两组胎死宫内发生率比较，差异无统计学意义（2．5％与2．8％，x2=0．026，P=0．871），但新生儿中重度窒息率（25．8％与10．8％，X2=20．792，P〈0．001）及围产儿病死率（22．O％与6．9％，x2=27．782，P〈0．001）比较，差异均有统计学意义。结论对于重度早发型子痫前期患者，在保证母亲安全的基础上采取适当的保守期待疗法，既可以避免或减少孕产妇严重并发症发生的可能性，又能适当延长孕龄，降低围产儿患病率和病死率，终止妊娠的方式以剖宫产为宜。Objective To discuss the safety and operation effect of cesarean sectionof patients with early onset severe preeclampsia.Methods Clinical data were retrospectively analyzed,the treatment group made up of 236 patients with severe preeclampsia whose gestational age from 28 to 33 +6 weeks and the control group with 399 pregnancy women above 34 weeks.Main analytical items included:onset of gestational age,gestational age of termination of pregnancy,protensive of gestation,methods of termination of pregnancy,status of the occurrence of serious complications,fetal and neonatal mortality and the rate of neonatal asphyxia.Results The average conservative treatment time of treatment group was was significantly longer than that of control group [ ( 13.5 ± 1.2) d vs (9.6 ± 1.0 ) d,t =3.760,P ＜ 0.001].There was no significant difference on the cesarean section rate[70.8％ (167/236) vs 71.2％ (284/399),x2 =0.012,P =0.911 ] and neonatal mortality(2.5％vs 2.8 ％,x2 =0.026,P =0.871 ) between these two gourps.However there was significant difference on the rate of neonatal asphyxia(25.8％ vs 10.8％,x2 =20.792,P ＜ 0.001 ) and perinatal mortalit (22.0％ vs 6.9％,x2=27.782,P ＜ 0.001 ) between these two groups.Conclusion For the patients with severe early onset preeclampsia,to take conservative expectant treatment appropriately based on the safety of motherhood could avoid or reduce the possibility of the occurrence of serious complications,could extend the gestational age appropriately as well as reduce fetal and neonatal prevalence and mortality.Cesarean section is proper for the termination of pregnancy.

关 键 词：重度早发型子痫前期 妊娠并发症 期待疗法 妊娠结局 

分 类 号：R714.2[医药卫生—妇产科学]