持续气道正压通气对阻塞性睡眠呼吸暂停综合征孕妇母儿结局的影响  

Effects of continuous positive airway pressure on maternal and neonatal outcomes in pregnant women with obstructive sleep apnea syndrome

作　　者：涂泽霖 白瑞 张林燕 王晶玉 洪申达 杨京晶[1] 魏俊[1] 王雁[1] 刘亚楠 董霄松[2] 韩芳[2] 刘国莉[1] Tu Zelin;Bai Rui;Zhang Linyan;Wang Jingyu;Hong Shenda;Yang Jingjing;Wei Jun;Wang Yan;Liu Yanan;Dong Xiaosong;Han Fang;Liu Guoli(Department of Obstetrics and Gynecology,Peking University People′s Hospital,Beijing 100044,China;Division of Sleep Medicine,Peking University People′s Hospital,Beijing 100044,China;National Institute of Health Data Science,Peking University,Beijing 100191,China)

机构地区：[1]北京大学人民医院妇产科,北京100044 [2]北京大学人民医院呼吸睡眠医学科,北京100044 [3]北京大学健康医疗大数据国家研究院,北京100191

出　　处：《中华妇产科杂志》2025年第3期171-176,共6页Chinese Journal of Obstetrics and Gynecology

基　　金：北京市自然科学基金(22JCZXJC00160)。

摘　　要：目的分析持续气道正压通气(CPAP)对阻塞性睡眠呼吸暂停综合征(OSAS)孕妇母儿结局的影响,尤其是对中重度OSAS孕妇妊娠期高血压疾病(HDP)发生的影响。方法选取2021年1月至2024年5月在北京大学人民医院进行产前检查,因OSAS高危因素行妊娠期睡眠监测确诊OSAS的孕妇180例进行回顾性分析。根据是否接受CPAP规范化治疗,分为CPAP组(42例)和对照组(138例),CPAP组中重度OSAS孕妇9例,对照组中重度OSAS孕妇34例。对两组孕妇的母儿结局,特别是HDP发生率及孕妇分娩后胎盘重量、胎盘重量/新生儿出生体重比进行比较。结果(1)CPAP组孕妇的分娩孕周晚于对照组[分别为(38.7±1.0)、(38.0±1.4)周],CPAP组小于胎龄儿(SGA)比例低于对照组[分别为0(0/42)、12.3%(17/138)],新生儿出生体重大于对照组[分别为(3396±475)、(3082±710)g],差异均有统计学意义(P均<0.05)。CPAP组与对照组孕妇的分娩方式、早产和产后出血发生率、脐动脉血气分析pH<7.1、乳酸≥6.0 mmol/L、碱剩余<-12.0 mmol/L占比、妊娠期糖尿病及HDP发生率分别比较,差异均无统计学意义(P均>0.05)。(2)CPAP组的胎盘重量小于对照组[(554.0±70.6)、(615.7±119.1)g],胎盘重量/新生儿出生体重比小于对照组(中位数分别为0.17、0.19),分别比较,差异均有统计学意义(P均<0.05)。(3)CPAP组的中重度OSAS孕妇HDP发生率小于对照组[分别为1/9、61.8%(21/34)],两组比较,差异有统计学意义(P<0.05)。结论CPAP治疗可以延长OSAS孕妇的分娩孕周,降低SGA的发生率,增加新生儿出生体重,同时显著降低中重度OSAS孕妇HDP的发生率,值得在临床推广。CPAP治疗改善新生儿结局与胎盘密切相关,值得进一步探究。ObjectiveTo analyze the effect of continuous positive airway pressure(CPAP)on maternal and neonatal outcomes in pregnant women with obstructive sleep apnea syndrome(OSAS),especially on the incidence of hypertensive disorder in pregnancy(HDP)in women with moderate to severe OSAS.MethodsA total of 180 pregnant women with OSAS who were diagnosed through sleep monitoring during pregnancy due to high-risk factors of OSAS and registered in Peking University People′s Hospital from January 2021 to May 2024 were selected as the study subjects.Clinical data were collected from medical records for retrospective analysis.According to whether they received standardized treatment with CPAP,they were divided into the CPAP treatment group(42 cases)and the control group(138 cases).The CPAP treatment group consisted of 9 pregnant women with moderate to severe OSAS,while the control group consisted of 34 pregnant women with moderate to severe OSAS.The maternal and neonatal outcomes,the incidence of HDP,placental weight after delivery and placental weight/neonatal birth weight ratio were compared between the two groups.Results(1)The average gestational age of pregnant women in the CPAP treatment group was higher than that in the control group[(38.7±1.0)vs(38.0±1.4)weeks],the proportion of infants small for gestational age(SGA)in the CPAP treatment group was lower[0(0/42)vs 12.3%(17/138)],and the birth weight of infants in the CPAP treatment group was bigger[(3396±475)vs(3082±710)g];the differences between the two groups were statistically significant(all P<0.05).There were no significant differences between the CPAP treatment group and the control group in terms of delivery mode,rates of postpartum hemorrhage and preterm birth,umbilical artery blood gas analysis pH<7.1,lactate≥6.0 mmol/L,base excess<-12.0 mmol/L and the incidence of gestational diabetes mellitus and HDP(all P>0.05).(2)The placental weight of the CPAP treatment group was significantly lower than that of the control group[(554.0±70.6)vs(615.7±119.1)g],the pl

关 键 词：睡眠呼吸暂停 阻塞性 连续气道正压通气 妊娠结局 

分 类 号：R714.7[医药卫生—妇产科学]