母亲妊娠期高血压疾病对早产儿病死率及主要并发症的影响  

Impact of hypertensive disorder complicating pregnancy on neonatal mortality and major complications in pre-term infants

作　　者：王梅玉 孔祥永[1,2] 封志纯 徐凤丹[3] 吕红艳 杨李红 吴素静[4] 巨容[5] 汪瑾[5] 彭立 李占魁 赵小林 曾淑娟 丘惠娴 温伟溪[7] 武辉[8] 李莹 李楠[8] 张雪峰[9] 贾文峥[9] 郭果[9] 刘卫鹏[10] 王凤 李改梅[10] 刘芳[11] 李薇[11] 赵晓英[11] 程红斌 许云波[12] 陈文超[12] 尹欢[12] 丁艳洁[13] 王晓亮[13] 单瑞艳[13] 许平[14] 韩梅盈[14] 杨春燕[14] 陈铁强 童笑梅[16] 刘少君[16] 刘子源[16] Wang Meiyu;Kong Xiangyong;Feng Zhichun;Xu Fengdan;Lyu Hongyan;Yang Lihong;Wu Sujing;Ju Rong;Wang Jin;Peng Li;Li Zhankui;Zhao Xiaolin;Zeng Shujuan;Qiu Huixian;Wen Weixi;Wu Hui;Li Ying;Li Nan;Zhang Xuefeng;Jia Wenzheng;Guo Guo;Liu Weipeng;Wang Feng;Li Gaimei;Liu Fang;Li Wei;Zhao Xiao-ying;Cheng Hongbin;Xu Yunbo;Chen Wenchao;Yin Huan;Ding Yanjie;Wang Xiaoliang;Shan Ruiyan;Xu Ping;Han Meiying;Yang Chunyan;Chen Tieqiang;Tong Xiaomei;Liu Shaojun;Liu Ziyuan(Army General Hospital Affiliated to Southern Medical University,Guangzhou 510515,China;Neonatal Intensive Care Unit,Affiliated Bayi Children＇ s Hospital,People＇ s Liberation Army General Hospital,National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology,Beijing Key Laboratory ofPediatric Organ Failure,Beijing 100700,Chin;Department of Pediatrics,Guangdong Medical University,Dongguan 523808,Guangdong Province,China;Department of Neonatology,Handan Maternity and Child Health Care Hospital,Handan 056001,Hebei Province,Chin;Depart-merit of Neonatology,Chengdu Women and Children＇ s Central Hospital,Chengdu 610091,Chin;Department of Neonatolngy,Shaanxi Maternal and Child Health Care Hospital,Xi＇an 710003,Chin;Department of Pediatrics,Longgang District Central Hospital of Shenzhen,Shenzhen 518116,Guangdong Province,Chin;Department of Pediatrics,the First Hospital of Jilin University,Changchun 130021,Chin;Department of Neonatology,302 Military Hospital of China,Beijing 100039,China;Department of Pediatrics,Navy General Hospital,Beijing 100048,China;epartment of Pediatrics,Bethune International Peace Hospital,Shijiazhuang 050082,Chin;epartment of Pediatrics,Huangshi Maternal and Child Health Care Hospital,Huangshi 435003,Hubei Province,Chin;epartment of Pediatrics,Yantai Yuhuangding Hospital,Yantai 264000,Shandong Province,Chin;epartment of Pediatrics,Liaocheng People＇ s Hospital,Liaocheng 252004,Shandong Province,Chin;epartment of Neonatology,Changsha Maternal and Child Health Care Hospital,Changsha 410007,Chin;epartment of Neonatol

机构地区：[1]南方医科大学陆军总医院,广州510515 [2]陆军总医院附属八一儿童医院新生儿科、出生缺陷防控关键技术国家工程实验室、儿童器官功能衰竭北京市重点实验室,北京100700 [3]广东医科大学儿科学教研室,广东东莞523808 [4]邯郸市妇幼保健院新生儿科,056001 [5]成都市妇女儿童中心医院新生儿科,610091 [6]陕西省妇幼保健院新生儿科,西安710003 [7]深圳市龙岗中心医院儿科,518116 [8]吉林大学第一医院儿科,长春130021 [9]解放军第302医院新生儿科,北京100039 [10]海军总医院儿科,北京100048 [11]白求恩国际和平医院儿科,石家庄050082 [12]黄石市妇幼保健院儿科,435003 [13]烟台毓璜顶医院儿科,山东烟台264000 [14]聊城市人民医院儿科,252004 [15]长沙市妇幼保健院新生儿科,410007 [16]北京大学第三医院新生儿科,100191

出　　处：《中华实用儿科临床杂志》2018年第14期1065-1070,共6页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金（81471492）

摘　　要：目的探讨母亲妊娠期高血压疾病（HDCP）对早产儿病死率及早期主要并发症的影响。方法收集本课题组各协作单位在2013年1月1日至2014年12月31日产科出生胎龄24～36＋6周早产儿的一般临床资料。按HDCP程度分为4组：HDCP组、子痫前期组、子痫组和无HDCP组，比较各组早产儿的病死率和主要并发症的发生率，并分析其影响因素。结果HDCP组早产儿病死率明显高于无HDCP组（χ2＝9.970，P＝0.019），其中以子痫前期病死率最高（4.8%），与无HDCP组（2.2%）比较差异具有统计学意义（P〈0.05），与HDCP组（1.8%）、子痫组（3.2%）比较差异无统计学意义。HDCP组呼吸窘迫综合征（RDS）发生率明显高于无HDCP组（χ2＝13.241，P＝0.004），其中子痫组发病率最高（35.4%），与无HDCP组（16.2%）比较，差异有统计学意义（P〈0.05），但与HDCP组（19.9%）、子痫前期组（17.1%）比较差异无统计学意义。HDCP组支气管肺发育不良（BPD）发生率明显高于无HDCP组（χ2＝9.592，P＝0.022），其中子痫组发病率最高（9.7%），与无HDCP组（2.0%）及HDCP组（1.7%）比较差异均有统计学意义（均P〈0.05），而与子痫前期组比较差异无统计学意义，且随着HDCP的程度加重，BPD的发生率逐渐升高。HDCP对脑室内出血（IVH）、坏死性小肠结肠炎（NEC）、早产儿视网膜病（ROP）、脓毒症无明显影响（χ2＝7.054、7.214、0.358、3.852，P＝0.070、0.065、0.949、0.278）。考虑患儿总体结局，即患儿死亡或存活但至少合并一种并发症，HDCP对其有影响（χ2＝15.697，P＝0.001），且随HDCP程度加重，其发生率逐渐增高。调整胎龄、出生体质量、性别、分娩方式、胎盘早剥、前置胎盘、产前激素、妊娠期糖尿病、新生儿窒息等因素，结果显示HDCP是导致早产儿死亡的危险因素（OR＝2.159，95%CI：1.093～4.266），而子痫前期组、子痫组之间�ObjectiveTo investigate the effect of hypertensive disorder complicating pregnancy （HDCP） on the mortality and early complications of premature infants.MethodsThe general clinical data of preterm infants with gestational age 24-36＋ 6 weeks were collected from the cooperative units in the task group from January 1, 2013 to December 31, 2014.According to the severity of HDCP, the infants were divided into 4 groups： HDCP group, preeclampsia group, eclampsia group and non HDCP group, the mortality and major complications of preterm infants were compared, and the influencing factors were analyzed.ResultsThe mortality rate of preterm in the HDCP group was significantly higher than that of non HDCP group, and there was statistical significance （χ2=9.970, P=0.019）. Eclampsia had a highest fatality rate （4.8%） in the early stage, compared with non HDCP group （2.2%）, and the difference was statistically significant.Comparison of HDCP group （1.8%） and eclampsia group （3.2%） suggested that there was no statistically significant difference.The incidence of respiratory distress syndrome （RDS） in preterm in HDCP group was significantly higher than that of non HDCP group, and there was statistical significance （χ2=13.241, P=0.004）. Eclampsia group showed the highest incidence （35.4%）, compared with non HDCP group （16.2%）, the difference was statistically significant, but compared with HDCP group （19.9%）, preeclampsia group （17.1%）, there was no significant diffe-rence.The incidence of bronchopulmonary dysplasia （BPD） in preterm in HDCP group was significantly higher than that of non HDCP group （χ2=9.592, P=0.022）, the highest incidence showed up in eclampsia group （9.7%）, compared with non HDCP group （2.0%） and HDCP group （1.7%）, the difference was statistically significant.But there was no statistically significant difference, compared with preeclampsia group.As the degree of HDCP aggravated, the incidence of BPD gradually rose.There was no significant i

关 键 词：妊娠期高血压疾病 早产儿 并发症 

分 类 号：R722.6[医药卫生—儿科]