早发型重度子痫前期孕妇期待治疗中不良妊娠结局的危险因素分析
조발형중도자간전기잉부기대치료중불량임신결국적위험인소분석
Risk factors of adverse pregnancy outcomes during expectant management of early onset severe pre-eclampsia
  • 万方数据
    中华妇产科杂志 중화부산과잡지
    CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
    2010年 3期 165-169 ,共5页

    伍绍文%吴连方%王琪%张为远

    오소문%오련방%왕기%장위원

    先兆子痫%综合疗法%妊娠结局%危险因素%红细胞计数%血小板计数 先兆子癇%綜閤療法%妊娠結跼%危險因素%紅細胞計數%血小闆計數
    선조자간%종합요법%임신결국%위험인소%홍세포계수%혈소판계수
    Pre-eclampsia%Combined modality therapy%Pregnancy outcome%Risk factors%Erythrocyte count%Platelet count
    目的 探讨早发型重度子痫前期孕妇实施期待治疗过程中发生不良妊娠结局的危险因素.方法 选择2007年1月至2008年6月在首都医科大学附属北京妇产医院住院的早发型重度子痫前期并实施期待疗法的孕妇136例.按照妊娠结局分为良好结局组101例和不良结局组35例.采用回顾性分析方法,分析两组孕妇人院时的一般资料、妊娠结局、尿常规、血流动力学及血常规指标、肝肾功能,另分析不良妊娠结局的危险因素.结果 (1)一般资料:良好结局组与不良结局组孕妇入院时出现子痫前期症状的发生率(分别为35.6%及57.1%)比较,差异有统计学意义(P<0.05).两组孕妇年龄、孕次、孕前体质指数、入院时并发症发生率及规律产前检查率比较,差异均无统计学意义(P>0.05).(2)妊娠结局:良好结局组孕妇期待疗法平均天数为(6.5±8.2)d,不良结局组平均为(6.8±10.0)d,两组比较,差异无统计学意义(P>0.05).不良结局组孕妇主要并发症为胎盘早剥13例,心功能衰竭及肺水肿10例,溶血、肝酶升高和低血小板计数(HELLP)综合征5例,胎死宫内5例,无子痫发生.良好结局组孕妇均无以上并发症发生.(3)期待疗法中发病孕周及分娩孕周、血压及尿蛋白比较:良好结局组的发病孕周及分娩孕周[分别为(33.0±4.9)及(34.0±3.6)周]明显晚于不良结局组[分别为(31.3±3.4)及(32.1±3.0)周],收缩压及尿蛋白定量明显低于不良结局组.良好结局组中尿蛋白定性(+++)比例明显低于不良结局组.以上指标两组比较,差异均有统计学意义(P<0.05).(4)血流动力学及血常规:良好结局组孕妇血液黏度[(4.6±0.4)mPa·s]明显低于不良结局组,两组比较,差异有统计学意义(P<0.05).而心输出量、心脏指数、外周阻力及血管顺应性等指标在两组孕妇中比较,差异均无统计学意义(P>O.05).良好结局组孕妇血小板计数[(189±69)×10~9/L]明显高于不良结局组,而红细胞计数[(3.9±0.5)×10~(12)/L]和红细胞压积(0.34±0.05)却明显低于不良结局组.两组比较,差异均有统计学意义(P<0.01).(5)肝肾功能:良好结局组孕妇丙氨酸氨基转移酶[ALT,(18±12)U/L]、天冬氨酸氨基转移酶[AST,(24±9)U/L]、乳酸脱氢酶[LDH,(175±53)U/L]及尿素氮[BUN,(4.6±1.8)mmol/L,]水平明显低于不良结局组.两组比较,差异均有统计学意义(P<0.05).而血浆总蛋白(TP)、血浆白蛋白(Alb)、尿酸(UA)及血肌酐(cr)水平在两组中比较,差异均无统计学意义(P>0.05).(6)不良结局的危险因素分析:进入logistic回归方程的自变量分别为红细胞计数(OR值为3.68,P=0.000),血小板计数(OR值为0.99,P=0.006)及分娩孕周(OR值为0.87,P=0.001).显示红细胞计数越高,则在期待疗法中越有可能出现不良妊娠结局;血小板计数越低、分娩孕周越早,则提示期待疗法中愈易出现不良妊娠结局.结论 红细胞计数升高、血小板计数降低及分娩孕周过早,是早发型重度子痫前期孕妇实施期待疗法过程中发生不良妊娠结局的危险因素.
    목적 탐토조발형중도자간전기잉부실시기대치료과정중발생불량임신결국적위험인소.방법 선택2007년1월지2008년6월재수도의과대학부속북경부산의원주원적조발형중도자간전기병실시기대요법적잉부136례.안조임신결국분위량호결국조101례화불량결국조35례.채용회고성분석방법,분석량조잉부인원시적일반자료、임신결국、뇨상규、혈류동역학급혈상규지표、간신공능,령분석불량임신결국적위험인소.결과 (1)일반자료:량호결국조여불량결국조잉부입원시출현자간전기증상적발생솔(분별위35.6%급57.1%)비교,차이유통계학의의(P<0.05).량조잉부년령、잉차、잉전체질지수、입원시병발증발생솔급규률산전검사솔비교,차이균무통계학의의(P>0.05).(2)임신결국:량호결국조잉부기대요법평균천수위(6.5±8.2)d,불량결국조평균위(6.8±10.0)d,량조비교,차이무통계학의의(P>0.05).불량결국조잉부주요병발증위태반조박13례,심공능쇠갈급폐수종10례,용혈、간매승고화저혈소판계수(HELLP)종합정5례,태사궁내5례,무자간발생.량호결국조잉부균무이상병발증발생.(3)기대요법중발병잉주급분면잉주、혈압급뇨단백비교:량호결국조적발병잉주급분면잉주[분별위(33.0±4.9)급(34.0±3.6)주]명현만우불량결국조[분별위(31.3±3.4)급(32.1±3.0)주],수축압급뇨단백정량명현저우불량결국조.량호결국조중뇨단백정성(+++)비례명현저우불량결국조.이상지표량조비교,차이균유통계학의의(P<0.05).(4)혈류동역학급혈상규:량호결국조잉부혈액점도[(4.6±0.4)mPa·s]명현저우불량결국조,량조비교,차이유통계학의의(P<0.05).이심수출량、심장지수、외주조력급혈관순응성등지표재량조잉부중비교,차이균무통계학의의(P>O.05).량호결국조잉부혈소판계수[(189±69)×10~9/L]명현고우불량결국조,이홍세포계수[(3.9±0.5)×10~(12)/L]화홍세포압적(0.34±0.05)각명현저우불량결국조.량조비교,차이균유통계학의의(P<0.01).(5)간신공능:량호결국조잉부병안산안기전이매[ALT,(18±12)U/L]、천동안산안기전이매[AST,(24±9)U/L]、유산탈경매[LDH,(175±53)U/L]급뇨소담[BUN,(4.6±1.8)mmol/L,]수평명현저우불량결국조.량조비교,차이균유통계학의의(P<0.05).이혈장총단백(TP)、혈장백단백(Alb)、뇨산(UA)급혈기항(cr)수평재량조중비교,차이균무통계학의의(P>0.05).(6)불량결국적위험인소분석:진입logistic회귀방정적자변량분별위홍세포계수(OR치위3.68,P=0.000),혈소판계수(OR치위0.99,P=0.006)급분면잉주(OR치위0.87,P=0.001).현시홍세포계수월고,칙재기대요법중월유가능출현불량임신결국;혈소판계수월저、분면잉주월조,칙제시기대요법중유역출현불량임신결국.결론 홍세포계수승고、혈소판계수강저급분면잉주과조,시조발형중도자간전기잉부실시기대요법과정중발생불량임신결국적위험인소.
    Objective To identify the risk factors of adverse pregnancy outcomes in expectant management of pregnant women with early onset severe pre-eclampsia (EOSP). Methods Totally, 136 gravidas, who were diagnosed as ESOP and received expectant management from January 2007 to June 2008 in Beijing Obstetrics and Gynecology Hospital, were selected and divided into two groups; the favorable pregnancy outcome group (control, n=101)and the adverse pregnancy outcome group (n=35).The general clinical information, pregnancy outcomes, routine urine test, hemodynamic data, routine blood test, liver and renal function test on admission were collected and the risk factors for adverse outcomes were retrospectively analyzed.Results (1)General clinical information; more women complained of preeclamptic symptoms on admission in the adverse outcome group than in the control group (35.6% vs.57.1 %,P< 0.05).No significant differences was found between the two groups in the maternal age, times of previous pregnancies, prevalence of concurrent complications, pre-pregnant body mass index (BMI),proportion of women who had regular antenatal checks(P > 0.05).(2) Pregnant outcomes; the average duration of expectant management in the control group were similar to the adverse outcomes group [(6.5 ± 8.2) days vs.(6.8 ±10.0) days, P > 0.05].The main complications in the adverse outcome group included placental abruption (n=13), heart failure and pulmonary edema (n=10),hemolysis, elevated liver enzymes and low platelet syndrome (HELIP syndrome, n=5),and no eclampsia was reported.However, none of these complications was reported from the control group.(3)Blood pressure and proteinuria; the gestation ages at the onset of EOSP and at delivery in the control group were earlier than those of the adverse outcome group [(31.3 ± 3.4) weeks vs.(33.0 ± 4.9) weeks, (32.1 ± 3.0) weeks vs.(34.0 ± 3.6) weeks, P< 0.05],the systolic blood pressure and urinary protein and the proportion of women with urinary protein of (+ + +)were also much higher in the adverse outcome group (all P<0.05).(4) Hemodynamics and routine blood tests; the blood viscosity in the control group was obviously lower than that of the adverse outcome group (P< 0.05 ).But there was no significant difference in the cardiac output, cardiac index, peripheral resistance and vascular compliance between the two groups (P >0.05).The adverse outcome group showed lower platelet(PLT) level and higher red blood cell(RBC) count and hematocrit compared with those of the control(all P<0.01).(5)Liver and renal function; the alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH),blood urea nitrogen(BUN) in the adverse outcome group were significantly higher than those of the control group (all P<0.05), but the plasma level of total protein (TP),albumin (Alb), uric acid (UA) and creatinine (Cr) were similar between the two groups(P>0.05).(6) Risk factor analysis: RBC count (OR =3.68, 95% CI: 1.90-7.13 ),PLT count (OR=0.99,95% CI:0.98-1.00) and the gestations at delivery (OR=0.87, 95% CI: 0.80-0.94) were the risk factors of adverse pregnancy outcomes during the expectant management of EOSP.Conclusion Elevated RBC count, reduced PLT count and earlier delivery weeks are the risk factors of adverse pregnancy outcomes during the expectant management of EOSP.
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