CAJ | 학술논문

目的探讨重度子(癎)前期并发腹水的临床特点及终止妊娠时机. 方法对179例重度子(癎)前期患者的临床资料进行回顾性分析,根据有无并发腹水分为腹水组(32例)和非腹水组(147例),分析两组孕妇一般情况、分娩方式、合并症/并发症(包括子(癎)、HELLP综合征、肝肾功能不全、心功能不全、低蛋白血症、胎盘早剥、产后出血、产褥感染).收集两组围产儿(腹水组38例,无腹水组157例)的临床资料,分别比较两组间和腹水组内胎龄＜32周,32周～,34周～,36周～组的小于胎龄儿(small for gestational age,SGA)的发生率和死亡率. 结果 (1)腹水组平均入院孕周和平均分娩孕周均早于无腹水组[入院:(32.5±2.1)周和(36.1±3.5)周,分娩:(34.1±2.3)周和(37.2±1.5)周,P均＜0.05).腹水组系统产前检查率低于无腹水组(25.0%和53.7%,P＜0.05).腹水组低蛋白血症(100.0%和47.0%)、肝肾功能不全(31.2%和8.2%)、HELLP综合征(9.4%和2.0%)、产后出血发生率(18.8%和2.0%)均高于无腹水组(P均＜0.05).(2)腹水组不同胎龄围产儿SGA发生率均高于同胎龄无腹水组,但仅胎龄＞36周组差异有统计学意义(7/9和30.2%,P＜0.05).腹水组胎龄＜32周和32周～围产儿死亡率高于无腹水组(＜32周:69.2%和19.2%,P＜0.05;32周～:2/7和0,P＜0.05).(3)腹水组内围产儿胎龄＜32周时围产儿死亡率较其他胎龄组高,胎龄＞36周围产儿SGA发生率最高(P＜0.05). 结论重度子(癎)前期并发腹水发病早,并发症多,母婴预后不佳.腹水是重度子(癎)前期的一个危险信号,应该引起产科医生的高度重视.对于重度子(癎)前期并发腹水围产儿,32～36周可能为终止妊娠的良好时机.
목적 탐토중도자(간)전기병발복수적림상특점급종지임신시궤. 방법 대179례중도자(간)전기환자적림상자료진행회고성분석,근거유무병발복수분위복수조(32례)화비복수조(147례),분석량조잉부일반정황、분면방식、합병증/병발증(포괄자(간)、HELLP종합정、간신공능불전、심공능불전、저단백혈증、태반조박、산후출혈、산욕감염).수집량조위산인(복수조38례,무복수조157례)적림상자료,분별비교량조간화복수조내태령＜32주,32주～,34주～,36주～조적소우태령인(small for gestational age,SGA)적발생솔화사망솔. 결과 (1)복수조평균입원잉주화평균분면잉주균조우무복수조[입원:(32.5±2.1)주화(36.1±3.5)주,분면:(34.1±2.3)주화(37.2±1.5)주,P균＜0.05).복수조계통산전검사솔저우무복수조(25.0%화53.7%,P＜0.05).복수조저단백혈증(100.0%화47.0%)、간신공능불전(31.2%화8.2%)、HELLP종합정(9.4%화2.0%)、산후출혈발생솔(18.8%화2.0%)균고우무복수조(P균＜0.05).(2)복수조불동태령위산인SGA발생솔균고우동태령무복수조,단부태령＞36주조차이유통계학의의(7/9화30.2%,P＜0.05).복수조태령＜32주화32주～위산인사망솔고우무복수조(＜32주:69.2%화19.2%,P＜0.05;32주～:2/7화0,P＜0.05).(3)복수조내위산인태령＜32주시위산인사망솔교기타태령조고,태령＞36주위산인SGA발생솔최고(P＜0.05). 결론 중도자(간)전기병발복수발병조,병발증다,모영예후불가.복수시중도자(간)전기적일개위험신호,응해인기산과의생적고도중시.대우중도자(간)전기병발복수위산인,32～36주가능위종지임신적량호시궤.
Objective To investigate the clinical characteristics and the optimal time of delivery in pregnant women with severe preeclampsia complicated with ascites. Methods A retrospective study was conducted on 179 severe preeclampsia mothers and their 195 neonates,presented in the First Affiliated Hospital of Wenzhou Medical College from Jan.2003 to Dec.2005,who were divided into two groups:32 complicated with ascites(ascites group)and 147 without(non-ascites group). The general conditions,mode of delivery and complications including eclampsia,hemolysis,elevated serum level of 1iver enzymes,and low platelets(HELLP syndrome),liver failure,renal failure,heart failure,hypoproteinemia,placental abruption,postpartum hemorrhage and puerperal infection,were also analyzed.Clinical data of all infants(38 from ascites group and 157 from non-ascites group)were analyzed.The incidence and mortality rate of small for gestational age(SGA)in both group within the same gestational age group and those between different gestational age groups in the ascites group were compared. Results (1)The average gestations at admission and delivery in the ascites group were earlier than the other[admission:(32.5±2.1)weeks vs(36.1±3.5)weeks;delivery:(34.1±2.3)weeks vs(37.2±1.5)weeks,P＜0.053.The rate of systemic antenatal care in the ascites group waslowcr than that of the non-ascites group(25.0%vs 53.7%,P＜0.05).More complications werefound in the ascites group than in the non-ascites group(hypoproteinemia:100.0%vs 47.0%;liver and renal failure:31.2%vs 8.2%;HELLP syndrome:9.4%vs 2.0%;postpartum hemorrhage:18.8%vs 2.0%;all P＜0.05).(2)The incidence of SGA in the ascites group was all higher than that in the non-ascites group,however,significant differences was only found between the tWO groups at＞36 weeks(7/9 vs 30.2%,P＜20.05).The perinatal mortalily rates of SGA in the ascites group at＜32 weeks and 32～34 weeks were significantly higher than that in the non-aseites group respectively(＜32 weeks:69.2%vs 19.2%,P＜0.05;32～34 weeks:2/7 vs 0,P＜0.05).(3)The highest perinatal mortality rate and the highest incidence of SGA in the ascites group were found in the groups of＜232 weeks and＞36 weeks,respectively. Conclusions The early onset of ascites and higher rate of complications in severe preeelamptie women implies the adverse maternaI and fetal outcomes.Ascites in severe preeclampsia cases should alert the clinicians.The optimal time for delivery might be at 32～36 weeks of gestations.