重度子痫前期各孕周早产儿预后与终止妊娠时机的探讨  

Study on the Prognosis of Premature Infants with Severe Preeclampsia and the Timing of Termination of Pregnancy

作　　者：罗世福[1] 黄团明 俞丽丽[1] 李发科[1] 彭珠芸[1] 郑英如[1] 李力[1] 胡章雪[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所,妇产科,检验科,儿科重庆400042

出　　处：《四川医学》2016年第4期409-413,共5页Sichuan Medical Journal

摘　　要：目的对比分析不同孕周的重度子痫前期的新生儿结局,并初步探讨重度子痫前期终止妊娠的时机。方法收集2009年7月至2014年12月于我院妇产科住院治疗并分娩的孕周〈37周的103例重度子痫前期的孕妇及其分娩的97例活产儿作为研究对象。分析孕妇的主要并发症（包括心力衰竭、肾功能不全、子痫、胎盘早剥、HELLP综合征和视网膜病变）,以及胎死宫内（Intrauterine fetal death,IUFD）、新生儿死亡、入住NICU率、新生儿呼吸窘迫综合征（Neonatal respiratory distress syndrome,NRDS）、新生儿窒息、是否使用有创呼吸机、是否使用肺泡表面活性物质（pulmonary surfactant,PS）及新生儿并发症（败血症、颅内出血、坏死性小肠结肠炎、脑瘫）等情况。结果新生儿现存活率随着孕周增加逐渐增加,而PS使用率、机械通气率、两项及两项以上近期并发症发生率及NRDS发生率随着孕周的增加而逐渐降低,孕周〉32周的各孕周新生儿存活率均较前三组孕周明显升高,差异有统计学意义（P〈0.05）,孕33周后新生儿机械通气率、两项及两项以上近期并发症发生率及NRDS发生率显著下降,差异有统计学意义（P〈0.05）。孕33~33＋6周与孕34~34＋6周相比较,新生儿现存活率、入住NICU率、PS使用率、机械通气率、NRDS的发生率、近远期并发症差异均无统计学意义（P〉0.05）。结论重度子痫前期早产儿的预后与分娩孕周密切相关,对孕周达33周以上的重度子痫前期患者,可采取提前终止妊娠的有效治疗措施;对胎龄28周以上,特别是已达31周的早产儿应采取积极的救治措施。Objective To compare and analyze the outcome of neonates with severe preeclampsia at different gestational weeks,and to explore the timing of termination of pregnancy in severe preeclampsia preliminarily. Methods Collected from July2009 to December 2014 in our hospital obstetrics and gynecology hospital treatment and delivery of less than 37 weeks of gestational age of 103 cases of severe preeclampsia pregnant women and their delivery of 97 cases of live births as the research object. Analysis of major complications of pregnant women（ including heart failure,renal insufficiency,eclampsia,placental early stripping,HELLP syndrome and retinopathy）,and intrauterine fetal death（ IUFD）,neonatal death,occupancy rate of NICU,neonatal respiratory distress syndrome（ NRDS）,asphyxia neonatorum,whether the use of invasive mechanical ventilation,whether the use of pulmonary surfactant and Neonatal complications（ sepsis,intracranial hemorrhage,necrotizing enterocolitis,cerebral palsy） and so on. Results The survival rate of neonates with gestational weeks increasing gradually increased,while the PS utilization rate,mechanical ventilation rate,two and two or more complications and the incidence of NRDS increased with the gestational age and gradually decreased,The gestational age of more than 32 weeks of each gestational week survival rates were significantly increased before three weeks of gestation group（ P〈0. 05） after 33 weeks of gestation,neonatal mechanical ventilation rate,two and two or more complications and the incidence of NRDS was significantly decreased（ P〈0. 05）. The gestational age 33-33＋ 6weeks compared with 34-34＋ 6weeks,neonatal survival rate,occupancy rate of NICU,PS utilization rate,mechanical ventilation rate,the incidence of NRDS,and the complications in near,long-term difference had no statistical significance（ P〉0. 05）. Conclusion The prognosis of prematureinfants with severe preeclampsia is closely related to the gestational weeks of delivery,and more than 33 weeks o

关 键 词：重度子痫前期 早产儿 预后 终止妊娠 

分 类 号：R714.244[医药卫生—妇产科学]