中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2012年
3期
147-152
,共6页
先兆子痫%危险因素%产前诊断%医师诊疗模式
先兆子癇%危險因素%產前診斷%醫師診療模式
선조자간%위험인소%산전진단%의사진료모식
Pre-eclampsia%Risk factors%Prenatal diagnosis%Physicians practice patterns
目的 探讨母体潜在风险因素在不同级别医院以及是否规律产前检查与子痫前期发病特点的关系. 方法 回顾分析300例在北京大学第三医院分娩的单胎妊娠子痫前期患者的临床资料.其中在三级医院、基层医院规律行产前检查和无规律产前检查者分别为100、81和119例.比较不同临床风险因素、产前检查情况者的子痫前期诊断孕周、重症发生情况.连续变量以中位数和四分位间距表示,采用非参数检验,分类变量采用卡方检验. 结果 (1)在总体病例、单纯子痫前期和合并慢性高血压者中,三级医院规律产前检查者(分别为100、64、14例)的子痫前期发病孕周[分别为37.1(4.1)、37.3(1.7)、36.3(2.5)周]比基层医院规律产前检查(分别为81、54、9例)的发病孕周[分别为32.9(6.7)、33.8(6.1)、27.9(6.3)周,Z值分别为72.29、51.30和14.58,P均＜0.05]和无规律产前检查者(分别为119、85、19例)子痫前期发病孕周[分别为31.6(6.6)、31.9(6.7)、30.3(4.7)周,Z值分别为86.69、58.83和11.33,P均＜0.05]明显延后；三级医院规律产前检查者比无规律产前检查者重症病例在妊娠32周前的发生率[分别为13.0％(13/100)与55.5％(66/119)、9.4％(6/64)与50.6％(43/85)、35.7％(5/14)与89.5％(17/19),x2值分别为43.95、29.42和10.17,P＜0.05)及妊娠34周前的发生率[分别为17.0％(17/100)与65.5％(78/119)、14.1％(9/64)与61.2％(52/85)、42.9％(6/14)与94.7％(18/19),x2值分别为47.71、31.18和10.61,P＜0.05]发生的比例明显降低.(2)在无规律产前检查组和基层医院规律产前检查组内,合并慢性高血压亚组比单纯子痫前期亚组的发病孕周明显提前(Z值分别为26.61和22.82,P＜0.05)；无规律产前检查组中,合并慢性高血压亚组比单纯子痫前期亚组的重症在妊娠32周前(x2=9.11,P＜0.05)和妊娠34周前(x2=7.95,P＜0.05)所占比例明显升高. 结论 三级医院规律产前检查可延缓子痫前期诊断孕周以及延缓重症发生时间,尤其对于存在子痫前期发病临床风险因素者.应加强早孕期子痫前期发病的临床风险评估,并建立以患者为基础的个体化系列产前检查计划.
目的 探討母體潛在風險因素在不同級彆醫院以及是否規律產前檢查與子癇前期髮病特點的關繫. 方法 迴顧分析300例在北京大學第三醫院分娩的單胎妊娠子癇前期患者的臨床資料.其中在三級醫院、基層醫院規律行產前檢查和無規律產前檢查者分彆為100、81和119例.比較不同臨床風險因素、產前檢查情況者的子癇前期診斷孕週、重癥髮生情況.連續變量以中位數和四分位間距錶示,採用非參數檢驗,分類變量採用卡方檢驗. 結果 (1)在總體病例、單純子癇前期和閤併慢性高血壓者中,三級醫院規律產前檢查者(分彆為100、64、14例)的子癇前期髮病孕週[分彆為37.1(4.1)、37.3(1.7)、36.3(2.5)週]比基層醫院規律產前檢查(分彆為81、54、9例)的髮病孕週[分彆為32.9(6.7)、33.8(6.1)、27.9(6.3)週,Z值分彆為72.29、51.30和14.58,P均＜0.05]和無規律產前檢查者(分彆為119、85、19例)子癇前期髮病孕週[分彆為31.6(6.6)、31.9(6.7)、30.3(4.7)週,Z值分彆為86.69、58.83和11.33,P均＜0.05]明顯延後；三級醫院規律產前檢查者比無規律產前檢查者重癥病例在妊娠32週前的髮生率[分彆為13.0％(13/100)與55.5％(66/119)、9.4％(6/64)與50.6％(43/85)、35.7％(5/14)與89.5％(17/19),x2值分彆為43.95、29.42和10.17,P＜0.05)及妊娠34週前的髮生率[分彆為17.0％(17/100)與65.5％(78/119)、14.1％(9/64)與61.2％(52/85)、42.9％(6/14)與94.7％(18/19),x2值分彆為47.71、31.18和10.61,P＜0.05]髮生的比例明顯降低.(2)在無規律產前檢查組和基層醫院規律產前檢查組內,閤併慢性高血壓亞組比單純子癇前期亞組的髮病孕週明顯提前(Z值分彆為26.61和22.82,P＜0.05)；無規律產前檢查組中,閤併慢性高血壓亞組比單純子癇前期亞組的重癥在妊娠32週前(x2=9.11,P＜0.05)和妊娠34週前(x2=7.95,P＜0.05)所佔比例明顯升高. 結論 三級醫院規律產前檢查可延緩子癇前期診斷孕週以及延緩重癥髮生時間,尤其對于存在子癇前期髮病臨床風險因素者.應加彊早孕期子癇前期髮病的臨床風險評估,併建立以患者為基礎的箇體化繫列產前檢查計劃.
목적 탐토모체잠재풍험인소재불동급별의원이급시부규률산전검사여자간전기발병특점적관계. 방법 회고분석300례재북경대학제삼의원분면적단태임신자간전기환자적림상자료.기중재삼급의원、기층의원규률행산전검사화무규률산전검사자분별위100、81화119례.비교불동림상풍험인소、산전검사정황자적자간전기진단잉주、중증발생정황.련속변량이중위수화사분위간거표시,채용비삼수검험,분류변량채용잡방검험. 결과 (1)재총체병례、단순자간전기화합병만성고혈압자중,삼급의원규률산전검사자(분별위100、64、14례)적자간전기발병잉주[분별위37.1(4.1)、37.3(1.7)、36.3(2.5)주]비기층의원규률산전검사(분별위81、54、9례)적발병잉주[분별위32.9(6.7)、33.8(6.1)、27.9(6.3)주,Z치분별위72.29、51.30화14.58,P균＜0.05]화무규률산전검사자(분별위119、85、19례)자간전기발병잉주[분별위31.6(6.6)、31.9(6.7)、30.3(4.7)주,Z치분별위86.69、58.83화11.33,P균＜0.05]명현연후；삼급의원규률산전검사자비무규률산전검사자중증병례재임신32주전적발생솔[분별위13.0％(13/100)여55.5％(66/119)、9.4％(6/64)여50.6％(43/85)、35.7％(5/14)여89.5％(17/19),x2치분별위43.95、29.42화10.17,P＜0.05)급임신34주전적발생솔[분별위17.0％(17/100)여65.5％(78/119)、14.1％(9/64)여61.2％(52/85)、42.9％(6/14)여94.7％(18/19),x2치분별위47.71、31.18화10.61,P＜0.05]발생적비례명현강저.(2)재무규률산전검사조화기층의원규률산전검사조내,합병만성고혈압아조비단순자간전기아조적발병잉주명현제전(Z치분별위26.61화22.82,P＜0.05)；무규률산전검사조중,합병만성고혈압아조비단순자간전기아조적중증재임신32주전(x2=9.11,P＜0.05)화임신34주전(x2=7.95,P＜0.05)소점비례명현승고. 결론 삼급의원규률산전검사가연완자간전기진단잉주이급연완중증발생시간,우기대우존재자간전기발병림상풍험인소자.응가강조잉기자간전기발병적림상풍험평고,병건립이환자위기출적개체화계렬산전검사계화.
Objective To investigate the relationship between potential maternal risk factors between potential maternal risk factors in different level hospitals as well as different prenatal care patterns and characteristics of preeclampsia. Methods A retrospective study of 300 preeclamptic singleton patients delivered in Peking University Third Hospital was performed.Patients were divided into three groups:regular prenatal care in tertiary hospitals (n =100),regular prenatal care in primary hospitals (n=81) and without prenatal care (n=119). The onset of preeclampsia and incidence of severe preeclampsia of different groups were analyzed. Non-parametric and Chi-square test were adopted for continuous and categorical variables respectively. Results (1) In total cases of preeclampsia subgroup (I-PE subgroup) and with chronic hypertension (CH subgroup),the diagnosis of preeclampsia was later in patient with regular prenatal care in tertiary hospital (patient-TH)[100,64 and 14 cases,37.1 (4.1),37.3 (1.7) and 36.3 (2.5) weeks respectively] than those with regular prenatal care in primary hospital (patient-PH) [81,54 and 9 cases,32.9 (6.7),33.8 (6.1)and 27.9(6.3) weeks respectively] (Z=72.29,51.30 and 14.58 respectively,P＜0.05) or the patient without regular prenatal care (patient-NP) [119,85 and 19 cases,31.6(6.6),31.9(6.7) and 30.3(4.7) weeks respectively] (Z=86.69,58.83 and 11.33 respectively,P＜0.05).The proportion of severe preeclampsia occurred earlier than 32 weeks [13.0％ (13/100) vs 55.5％ (66/119),9.4％(6/64) vs 50.6％(43/85),and 35.7％(5/14) vs 89.5％(17/19); x2=43.95,29.42 and 10.17respectively,P＜0.05] or earlier than 34 weeks [17.0％ (17/100) vs 65.5％ (78/119),14.1％(9/64) vs 61.2％(52/85) and 42.9％(6/14) vs 94.7％(18/19); x2 =47.71,31.18 and 10.61 respectively,P＜0.05] were lower in patient-TH than in patient-NP.(2) In patient-NP and patientPH,onset of preeclampsia was earlier in CH subgroup compared with I-PE subgroup (Z=26.61 and 22.82,P＜ 0.05). In patient-NP,the proportion of severe preeclampsia occurred earlier than 32 weeks (x2 =9.11,P＜0.05) or earlier than 34 weeks (x2 =7.95,P＜0.05) was higher in CH subgroup than in I-PE subgroup. Conclusions Regular prenatal care in tertiary hospital might effectively delay the onset of preeclampsia or severe preeclampsia,especially in patients with risk factors for preeclampsia. Assessment of risk factors for preeclampsia in early trimester should be strengthened and individualized prenatal care plan should be established.
