子痫前期患者胎盘血管铸型特点与三联药物治疗对改善其胎盘血管灌注功能的研究  

Characteristic of vascular casting of human placental with preeclampsia and improvement of its blood-priming function with treatment of trigeminy drugs

作　　者：尹格平[1] 陈铭[1] 李秀云[1] 杨树君[1] 李娟[1] 袁峥[1] 武爱芳[1] 

机构地区：[1]济南军区总医院妇产科,全军计划生育优生优育技术中心,250031

出　　处：《中华妇幼临床医学杂志（电子版）》2015年第5期589-594,共6页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：全军科研基金项目(08D016)~~

摘　　要：目的探讨子痫前期(PE)患者胎盘血管结构的临床意义,以及低剂量肠溶阿司匹林、硝苯地平和沙丁胺醇三联药物,对改善其胎盘灌注功能的作用。方法选择2006年8月至2013年8月在济南军区总医院住院分娩的158例PE患者为研究对象。按照分娩时药物应用情况,将其分为MgSO4组(n=54,采用MgSO4解痉),硝苯地平组(n=48,采用硝苯地平治疗),三联组(n=56,联合采用低剂量肠溶阿司匹林、沙丁胺醇和硝苯地平治疗)。选择同期于同一家医院住院分娩的86例正常、足月孕妇纳入正常组。采用改良胎盘血管铸型技术,对4组受试者胎盘铸型,并分析其特点。应用流式细胞术测定4组受试者红细胞内Ca2+(IECa2+)水平,并统计学分析其产前、产时及产后第5天IECa2+水平变化。统计学分析MgSO4组、硝苯地平组和三联组中,轻度、重度PE患者分娩新生儿轻、重度窒息,胎儿宫内生长受限(FGR)及死胎发生率。MgSO4组、硝苯地平组、三联组及正常组受试者年龄、分娩孕龄等一般临床资料比较,差异均无统计学意义(P>0.05)。结果1成功制作正常组受试者与PE患者胎盘血管标本,并各具有其特点。MgSO4组、硝苯地平组及三联组重度PE患者胎盘血管容积为(102.8±46.1)mL,显著小于正常组的(152.5±55.3)mL,二者比较,差异有统计学意义(t=2.707,P<0.01)。2正常组孕妇产前及产时IECa2+水平分别为(1 101.7±89.2)FC和(1 173.5±86.2)FC,二者比较,差异有统计学意义(t=2.843,P<0.01)。MgSO4组、硝苯地平组及三联组中重度PE患者产前、产时及产后第5天IECa2+水平较正常组相同时间点的IECa2+水平均显著增加,且差异均有统计学意义(t=2.118,2.134,2.003;2.140,2.079,2.083;2.721,2.109,2.152;P<0.05)。3三联组重度PE患者分娩新生儿轻、重度窒息,FGR和死胎发生率均显著低于MgSO4组,差异均有统计学意义(χ2=64.10,67.21,65.31,69.10;P<0.05),与硝苯地平组比较,差异均无统计学意义(P=0.636,0Objective To investigate clinic significance of vascular casting of three-dimensional structure in human normal pregnancy and preeclampsia （PE） placental, and effect of improvement of its blood-priming function with treatment by trigeminy drugs as aspirin, nifedipine and salhutamol. Methods From August 2006 to August 2013, a total of 158 cases of pregnant women with PE were chosen as study subjects. According to their treatment strategies during delivery, they were divided into MgSO4 group （n= 54, antispasmodic treatment by MgSO4 ）, nifedipine group （n=48, treatment by nifedipine） and trigeminy drugs group （n=56, treatment by trigeminy drugs as aspirin, nifedipine and salbutamol）. During the same period and in the same hospital, a total of 86 cases of normal and full-term pregnant women were included into normal group. Modified method of cast of placenta vascular was performed to cast placental vascular in 4 groups and their characteristics were analyzed. Intra erythrocyte Ca2＋ （IECa2＋ ） levels among 4 groups were measured and incidence of neonatal mild, severe asphyxia, fetal intrauterine growth restriction （FGR）, and stillbirth among mild, severe PE pregnant women were analyzed by statistical methods. There were no significat differences among 4 groups in age, gestational age at delivery etc. （P 〉 0. 05）. Results ①The three dimensional structure in human placentas with normal and PE pregnancy were revealed. The volume of placental vascular bed in sever PE was statistically less than that in normal group [（102.8±46.1） mL vs （152.5±55.3） mL], and there was significance difference （t=2. 707, P〈0.01）. ②IECa2＋ levels in normal group were （1 101.74±89.2） FC before deliver stage, and （1 173.5±86.2） FC during deliver stage, and the difference was statistically different （t= 2. 843, P〈0.01）. However the IECa2＋ levels of ones with sever PE in MgSO4 group, nifedipine group and trigeminy drugs group showed statistically higher than those in normal gr

关 键 词：先兆子痫 胎盘 血管铸型 妊娠结局 血流灌注 窒息 婴儿 新生 

分 类 号：R714.244[医药卫生—妇产科学]