中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2012年
6期
422-426
,共5页
张超%尹璐瑶%梁梅英%王山米%张晓红%王建六
張超%尹璐瑤%樑梅英%王山米%張曉紅%王建六
장초%윤로요%량매영%왕산미%장효홍%왕건륙
妊娠并发症,血液%贫血,再生障碍性%先兆子痫%妊娠结局%危险因素
妊娠併髮癥,血液%貧血,再生障礙性%先兆子癇%妊娠結跼%危險因素
임신병발증,혈액%빈혈,재생장애성%선조자간%임신결국%위험인소
Pregnancy complications,hematologic%Anemia,aplastic%Pre-eclampsia%Pregnancy outcome%Risk factors
目的 通过分析妊娠合并慢性再生障碍性贫血(慢性再障)患者的产科处理及妊娠结局,探讨其并发子痫前期的危险因素.方法 对北京大学人民医院2002年5月至2011年2月收治的41例妊娠合并慢性再障患者的临床资料中的产科处理、实验室检测结果及妊娠结局进行回顾性分析,采用多因素回归分析方法对妊娠合并慢性再障患者的妊娠并发症子痫前期的危险因素进行分析.结果 (1)41例妊娠合并慢性再障患者孕前诊断明确28例(28/41,68％),孕期诊断13例(13/41,32％);11例( 11/41,27％)患者于妊娠晚期出现轻微出血倾向,7例重型再障患者均有出血倾向.(2)41例妊娠合并慢性再障患者的中位白细胞计数5.0 × 109/L,中位血红蛋白含量66.0g/L,中位血小板计数12.0×109/L.(3)产科处理包括严密的病情评估及随诊复查,适时输血支持治疗,及时发现妊娠并发症,适时终止妊娠.其中21例患者孕期接受输血支持治疗,10例(10/41,24％)并发子痫前期(均为重度子痫前期),12例(12/41,29％)发生产后出血,其中3例出血量超过1000 ml,均保守治疗成功.(4)41例患者的终止妊娠中位孕周为37周,其中16例患者分娩孕周不足37周,早产率为39％( 16/41),5例患者分娩孕周不足34周；2例患者分别于孕29周及30周时发生重度子痫前期,新生儿因重度窒息死亡.活产新生儿出生体质量为1500 -3660 g.(5)产后随访时间6个月至7年,33例患者血红蛋白含量及血小板计数减少程度均有不同程度改善,不需要依赖输血；4例患者血红蛋白含量或血小板计数减少程度无明显好转,仍需间断输血,4例患者失访.(6)对并发子痫前期的10例患者与未发生子痫前期的31例患者进行单因素分析,结果显示,两者在出血倾向、血小板计数及终止妊娠孕周方面存在显著差异(P＜0.05)；而在年龄、首次产检孕周、孕前即明确诊断的患者比例、重型再障患者的比例、孕期治疗方案、白细胞计数及血红蛋白含量方面比较,差异均无统计学意义(P＞0.05).血小板计数≤10×109/L是妊娠合并慢性再障患者发生子痫前期的独立危险因素(P=0.006).结论 妊娠合并慢性再障患者经过严密的产前保健及支持治疗,多数可获得良好的妊娠结局,其并发症以重度子痫前期最为常见,血小板计数≤10×109/L可能是慢性再障患者并发子痫前期的独立危险因素.
目的 通過分析妊娠閤併慢性再生障礙性貧血(慢性再障)患者的產科處理及妊娠結跼,探討其併髮子癇前期的危險因素.方法 對北京大學人民醫院2002年5月至2011年2月收治的41例妊娠閤併慢性再障患者的臨床資料中的產科處理、實驗室檢測結果及妊娠結跼進行迴顧性分析,採用多因素迴歸分析方法對妊娠閤併慢性再障患者的妊娠併髮癥子癇前期的危險因素進行分析.結果 (1)41例妊娠閤併慢性再障患者孕前診斷明確28例(28/41,68％),孕期診斷13例(13/41,32％);11例( 11/41,27％)患者于妊娠晚期齣現輕微齣血傾嚮,7例重型再障患者均有齣血傾嚮.(2)41例妊娠閤併慢性再障患者的中位白細胞計數5.0 × 109/L,中位血紅蛋白含量66.0g/L,中位血小闆計數12.0×109/L.(3)產科處理包括嚴密的病情評估及隨診複查,適時輸血支持治療,及時髮現妊娠併髮癥,適時終止妊娠.其中21例患者孕期接受輸血支持治療,10例(10/41,24％)併髮子癇前期(均為重度子癇前期),12例(12/41,29％)髮生產後齣血,其中3例齣血量超過1000 ml,均保守治療成功.(4)41例患者的終止妊娠中位孕週為37週,其中16例患者分娩孕週不足37週,早產率為39％( 16/41),5例患者分娩孕週不足34週；2例患者分彆于孕29週及30週時髮生重度子癇前期,新生兒因重度窒息死亡.活產新生兒齣生體質量為1500 -3660 g.(5)產後隨訪時間6箇月至7年,33例患者血紅蛋白含量及血小闆計數減少程度均有不同程度改善,不需要依賴輸血；4例患者血紅蛋白含量或血小闆計數減少程度無明顯好轉,仍需間斷輸血,4例患者失訪.(6)對併髮子癇前期的10例患者與未髮生子癇前期的31例患者進行單因素分析,結果顯示,兩者在齣血傾嚮、血小闆計數及終止妊娠孕週方麵存在顯著差異(P＜0.05)；而在年齡、首次產檢孕週、孕前即明確診斷的患者比例、重型再障患者的比例、孕期治療方案、白細胞計數及血紅蛋白含量方麵比較,差異均無統計學意義(P＞0.05).血小闆計數≤10×109/L是妊娠閤併慢性再障患者髮生子癇前期的獨立危險因素(P=0.006).結論 妊娠閤併慢性再障患者經過嚴密的產前保健及支持治療,多數可穫得良好的妊娠結跼,其併髮癥以重度子癇前期最為常見,血小闆計數≤10×109/L可能是慢性再障患者併髮子癇前期的獨立危險因素.
목적 통과분석임신합병만성재생장애성빈혈(만성재장)환자적산과처리급임신결국,탐토기병발자간전기적위험인소.방법 대북경대학인민의원2002년5월지2011년2월수치적41례임신합병만성재장환자적림상자료중적산과처리、실험실검측결과급임신결국진행회고성분석,채용다인소회귀분석방법대임신합병만성재장환자적임신병발증자간전기적위험인소진행분석.결과 (1)41례임신합병만성재장환자잉전진단명학28례(28/41,68％),잉기진단13례(13/41,32％);11례( 11/41,27％)환자우임신만기출현경미출혈경향,7례중형재장환자균유출혈경향.(2)41례임신합병만성재장환자적중위백세포계수5.0 × 109/L,중위혈홍단백함량66.0g/L,중위혈소판계수12.0×109/L.(3)산과처리포괄엄밀적병정평고급수진복사,괄시수혈지지치료,급시발현임신병발증,괄시종지임신.기중21례환자잉기접수수혈지지치료,10례(10/41,24％)병발자간전기(균위중도자간전기),12례(12/41,29％)발생산후출혈,기중3례출혈량초과1000 ml,균보수치료성공.(4)41례환자적종지임신중위잉주위37주,기중16례환자분면잉주불족37주,조산솔위39％( 16/41),5례환자분면잉주불족34주；2례환자분별우잉29주급30주시발생중도자간전기,신생인인중도질식사망.활산신생인출생체질량위1500 -3660 g.(5)산후수방시간6개월지7년,33례환자혈홍단백함량급혈소판계수감소정도균유불동정도개선,불수요의뢰수혈；4례환자혈홍단백함량혹혈소판계수감소정도무명현호전,잉수간단수혈,4례환자실방.(6)대병발자간전기적10례환자여미발생자간전기적31례환자진행단인소분석,결과현시,량자재출혈경향、혈소판계수급종지임신잉주방면존재현저차이(P＜0.05)；이재년령、수차산검잉주、잉전즉명학진단적환자비례、중형재장환자적비례、잉기치료방안、백세포계수급혈홍단백함량방면비교,차이균무통계학의의(P＞0.05).혈소판계수≤10×109/L시임신합병만성재장환자발생자간전기적독립위험인소(P=0.006).결론 임신합병만성재장환자경과엄밀적산전보건급지지치료,다수가획득량호적임신결국,기병발증이중도자간전기최위상견,혈소판계수≤10×109/L가능시만성재장환자병발자간전기적독립위험인소.
Objective To investigate the risk factors for preeclampsia (PE) in pregnancies complicated with chronic aplastic anemia ( CAA ) by analyzing the obstetric management and pregnancy outcome.Methods Retrospectively review the clinical data including the obstetric management,the laboratory findings and the pregnancy outcome of 41 pregnant women complicated with CAA,all of whom were hospitalized in Peking University People's Hospital from May 2002 to February 2011.Multiple logistic regression was used to explore the risk factors associated with PE.Results ( 1 ) Twenty-eight patients were diagnosed before conception while 13 were diagnosed during gestation.Eleven patients including all the 7 who were categorized as severe CAA presented with mild bleeding in the third trimester.( 2 ) The medians of white blood cell counts,hemoglobin concentrations and platelet counts were 5.0 × 109/L,66.0 g/L and 12.0 × 109/L respectively.(3) The obstetric management consisted of strict assessment, intensive surveillance and follow-up,appropriate supportive measures,timely recognition of complications,and delivery when necessary.Twenty-one patients received supportive transfusions.Ten patients developed PE,all of whom were diagnosed as severe PE( SPE).Twelve patients suffered postpartum hemorrhage,and 3 of them had blood loss more than 1000 mL All were conservatively treated in success.(4) The median gestational age of delivery was 37 weeks.Sixteen cases delivered before 37 weeks and 5 delivered before 34 weeks.Two patients developed SPE at 29 weeks and 30 weeks respectively,and both of the neonates died for severe asphyxia.The birth weight of the live neonates ranged from 1500 to 3660 g.(5) The postpartum follow-up period ranged from 6 months to 7 years.Thirty-three patients got improvement without dependence on transfusions.Four achieved no remission and still needed intermittent transfusions.Four were lost in followup.(6) Significant differences were found in the bleeding tendency,the platelet counts and the delivery weeks when comparing the patients developing PE and those without PE.No differences were found with regard to the age,the gestational age of first visit,the percentage of patients diagnosed before conception,the percentage of severe CAA,the choice of treatment,the white blood cell counts and the hemoglobin level.The Multiple logistic regression showed that the platelet count less than 10 × 109/L was an independent risk factor for CAA patients developing PE (P =0.006).Conclusions Most pregnancies complicated with CAA could achieve good maternal and fetal outcome, when intensive prenatal care and supportive management are provided SPE is the most common complication.The platelet count less than 10 × 109/L is perhaps an independent risk factor for CAA patients developing PE.
