不同转诊时机对转诊系统内重度子痫前期孕妇妊娠结局的影响  

Impact of different referral timing on the pregnancy outcomes of severe pre-eclampsia in the referral system

作　　者：林雪燕 杨孜[1] 史峻梅 李凤秋[2] Lin Xueyan;Yang Zi;Shi Junmei;Li Fengqiu(Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China;Department of Obstetrics,Haidian Maternal and Child Health Hospital,Beijing 100080,China)

机构地区：[1]北京大学第三医院妇产科,北京100191 [2]北京市海淀区妇幼保健院产科,北京100080

出　　处：《中华妇产科杂志》2022年第3期164-171,共8页Chinese Journal of Obstetrics and Gynecology

基　　金：北京市科技计划(Z171100001017231)。

摘　　要：目的:分析转诊系统内不同临床转诊时机由基层医院转诊至三级医疗中心的重度子痫前期(SPE)孕妇的母儿结局,探讨转诊时机对延缓早发子痫前期、减少SPE及其严重并发症发生和改善母儿结局的影响。方法:通过临床观察研究,对2020年1月至2021年10月北京大学第三医院接受转诊并治疗后终止妊娠的159例SPE孕妇的临床资料进行分析。按转诊时的临床阶段分为发生SPE严重并发症后转诊38例(SPE-C组)、诊断SPE后转诊72例(a-SPE组)、诊断子痫前期后转诊15例(a-PE组)以及发现PE预警因素后转诊34例(Warn-s组)。再根据“高危孕产妇专案管理制度”五色系风险分类将159例转诊孕妇进行五色系分组,红色(高风险)及橙色(较高风险)为要求转诊至三级医院诊疗(红橙组,113例),黄色(一般风险)可在三级以下医院诊疗(黄色组,46例)。分析比较不同转诊时机的母儿结局及转诊时机对妊娠结局的影响。结果:(1)临床阶段分组:159例转诊孕妇中,转诊临床阶段越晚,SPE严重并发症的发生率越高,转诊至终止妊娠间隔越短。SPE-C组的严重并发症发生率显著高于其他3组,转诊至终止妊娠间隔显著短于其他3组(P均<0.05)。Warn-s组的转诊孕周早于其他3组(P均<0.05),SPE发生孕周、妊娠终止孕周、SPE严重并发症发生孕周均在妊娠34周以后,显著晚于a-SPE组及SPE-C组(P均<0.05);并且孕34周前SPE发生率、孕34周前SPE严重并发症发生率、孕34周前妊娠终止率、新生儿重症监护病房(NICU)入住率、NICU入住时长、孕28周前妊娠放弃率均显著低于a-SPE组和SPE-C组;活婴出院率为100%,显著高于a-SPE组和SPE-C组(P均<0.05)。a-PE组的SPE发生孕周和妊娠终止孕周也显著晚于a-SPE组及SPE-C组(P均<0.05);孕34周前SPE发生率、孕34周前妊娠终止率、NICU入住率、NICU入住时长显著低于a-SPE组及SPE-C组(P均<0.05)。(2)五色系风险分组:按照妊娠风险五色系分类转诊Objective To explore the impact of different referral timing on postponing early-onset pre-eclampsia(PE),postponing severe pre-eclampsia(SPE),reducing SPE severe complications and improving maternal and neonatal outcomes by analyzing the pregnancy outcomes of SPE patients who were referred from primary hospitals to tertiary referral center in the referral system.Methods The clinical data of 159 SPE patients who were referred from primary hospitals,treated and then terminated their pregnancy in Peking University Third Hospital from January 2020 to October 2021,were observed and analyzed in this clinical observational study.According to the clinical stage of PE at the time of referral,they were divided into four groups:38 cases were referred after onset of SPE severe complications(SPE-C group),72 cases were referred after onset of SPE(a-SPE group),15 cases were referred after onset of PE(a-PE group)and 34 cases were referred after detection of PE early warning-signs(Warn-s group).And then these 159 cases were divided into different color groups according to the project management system for high-risk pregnant women.Patients of Red color(highest risk)and Orange color(higher risk)were required to be referred to tertiary hospitals(Red-Orange group,113 cases),and patients of Yellow color(high risk)could be treated under tertiary hospitals(Yellow group,46 cases).The maternal and neonatal outcomes of different referral timings were analyzed and compared.Results(1)Pregnancy outcomes of different referral timings grouped by PE clinical stage at the time of referral:the later the referral timing,the higher the rate of SPE severe complications,the shorter the interval from referral to termination of pregnancy.The rate of SPE severe complications in the SPE-C group was significantly higher than those of the other three groups,and the interval from referral to termination of pregnancy in the SPE-C group was significantly shorter than those of the other three groups(all P<0.05).The referral gestational age of Warn-s group was e

关 键 词：先兆子痫 病人转诊 时间 妊娠结局 医院 县 医院 区 

分 类 号：R714.244[医药卫生—妇产科学]