重度子痫前期史患者低剂量阿司匹林预防用药的再次妊娠结局分析  

The Pregnancy outcome of Low-dose Aspirin for Prevention of Preeclampsia in the Patients with Previous Severe Preeclampsia

作　　者：傅勤[1] 陈昕华[2] 林建华[1] FU Qin;CHEN Xinhua;LIN Jianhua(Department of Obstetrics and Gynecology,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China;Department of Obstetrics and Gynecology,Ruijin Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属仁济医院妇产科,上海200127 [2]上海交通大学医学院附属瑞金医院妇产科,上海200025

出　　处：《实用妇产科杂志》2020年第10期752-756,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨重度子痫前期史患者再次妊娠后于不同孕周预防性应用低剂量阿司匹林的妊娠结局。方法:收集2018年1月1日至2018年12月31日上海交通大学医学院附属仁济医院分娩的117例重度子痫前期史患者的临床资料,研究组<孕12周(研究A组)和≥孕12周(研究B组)予阿司匹林75 mg/d预防用药,外院转入有重度子痫前期史但本次妊娠未用阿司匹林治疗的患者为对照组。比较各组子痫前期再次发生率、分娩孕周及母胎并发症。结果:研究组子痫前期发生率(25.3%)低于对照组(76.5%),其中研究A组子痫前期发生率(6.5%)低于研究B组(36.5%),差异有统计学意义(P<0.05)。体质量指数(BMI)≥25 kg/m^2、年龄≥35岁和合并糖尿病患者中研究组子痫前期发生率低于对照组,差异有统计学意义(P<0.05)。研究组HELLP综合征、胸腹水、胎儿生长受限、死胎发生率低于对照组,差异有统计学意义(P<0.05);研究A组和B组比较差异无统计学意义(P>0.05)。胎盘早剥发生率各组差异无统计学意义(P>0.05)。研究组分娩孕周大于对照组,研究A组大于B组;研究组早产发生率明显低于对照组,研究A组低于B组,各组差异均有统计学意义(P<0.05)。结论:重度子痫前期史患者再次妊娠时预防性应用低剂量阿司匹林可以明显降低子痫前期复发率和延长分娩孕周,从而改善母儿妊娠结局,对降低肥胖、高龄、合并糖尿病的重度子痫前期史患者的子痫前期复发效果明显。而选择小于孕12周的用药时机,对降低子痫前期复发、早产的发生和延长分娩孕周的效果更显著。Objective:To evaluate the effect of low-dose aspirin in different gestational age on pregnancy outcome in the patients with a history of severe preeclampsia.Methods:The data of 117 cases of patients with a history of severe preeclampsia who delivered at Renji Hospital between Jan 1st,2018 and Dec 31st,2018 was collected.The treatment group was preventively administrated with aspirin(75 mg/d)before(group A)and after(group B)12 weeks of gestation.Patients who transferredfrom other hosiptals without aspirin use were entrolled as control group.The incidence of preeclampsia,the gestational age at delivery and fetal and maternal complications among these groups were compared.Results:The incidence of preeclampsia in treatment group was lower than that in control group(25.3%vs 76.5%).It was 6.5%in group A and 36.5%in group B,the differences were statistically signifiant(P<0.05).The incidence of preeclampsia in the patients with BMI≥25 kg/m2,maternal age≥35 years and complicated with diabetes in the treatment group was lower than that in control group(P<0.05).The incidence of HELLP syndrome,pleuraland peritoneal effusion,fetal growth restriction and fetal death in treatment group was significantly lower than that of control group(P<0.05).There was no significant differences between group A and group B(P>0.05).The incidence of placental abruption was not significantly different among these groups(P>0.05).The gestatioal age at delivery was larger in treatment group compared with control group.The rate of preterm birth was lower in the treatment group than that in the control group.The differences were statistically significant among these groups(P<0.05).Conclusions:Prophylactic administration of lowdose aspirin in patients with a history of severe preeclampsia could significantly reduce the recurrence of preeclampsia and prolong the gestational week of delivery,thus improving maternal and fetal pregnancy outcomes.It has an obvious effect on reducing the recurrence of preeclampsia in patients with obesity,advanced age an

关 键 词：重度子痫前期史 阿司匹林 预防 妊娠结局 

分 类 号：R714.14[医药卫生—妇产科学]