131例双胎妊娠并发重度子痫前期的妊娠结局
131례쌍태임신병발중도자간전기적임신결국
Pregnancy outcomes of 131 twin pregnancies complicated with severe pre-eclampsia
  • 万方数据
    中华围产医学杂志 중화위산의학잡지
    CHINESE JOURNAL OF PERINATAL MEDICINE
    2013年 2期 65-70 ,共6页

    王姗%罗方媛%何国琳%刘兴会

    왕산%라방원%하국림%류흥회

    妊娠,多胎%先兆子痫%妊娠结局%危险因素 妊娠,多胎%先兆子癇%妊娠結跼%危險因素
    임신,다태%선조자간%임신결국%위험인소
    Pregnancy,multiple%Pre-eclampsia%Pregnancy outcome%Risk factors
    目的 探讨双胎妊娠并发重度子痫前期孕产妇的临床特点及其妊娠结局.方法 研究对象为2007年6月至2011年6月期间,四川大学华西第二医院收治的703例重度子痫前期病例,其中双胎妊娠131例,单胎妊娠572例.采用回顾性分析的方法,比较双胎组和单胎组孕妇的年龄、规律产检次数、发病孕周、分娩孕周、平均延长孕龄、血压值及实验室检测结果等临床指标,比较胎盘早剥、产后出血、子宫胎盘卒中、子痫、HELLP综合征(hemolysis,elevated liver enzymes,and low platelets syndrome)等产科并发症,以及心功能衰竭、肺水肿、低蛋白血症、视网膜病变、颅内出血和肾功能不全等并发症发生情况.比较双胎组和单胎组围产儿的结局,包括早产率、围产儿死亡率、新生儿重症监护室(neonatal intensive care unit,NICU)转入率,以及胎儿窘迫、新生儿缺血缺氧性脑病(hypoxie ischemic encephalopathy,HIE)、新生儿窒息、肺炎、高胆红素血症和低血糖等疾病的发生率.采用t检验、x2检验、校正四格表的x2检验或Fisher精确概率法进行统计学分析.结果 双胎组重度子痫前期发病率高于单胎组[5.03％(131/2604)与1.94％(572/29 452),x2=106.40,P＜0.001].双胎组和单胎组的平均发病孕周分别为(33.6±1.8)周和(34.4±2.0)周,平均分娩孕周分别为(34.6±2.9)周和(35.6±3.2)周,平均延长孕龄分别为(6.4±0.3)d和(7.4±0.5)d,双胎组均早于单胎组(t=2.364、3.902和5.314,P均＜0.05).双胎组与单胎组胎盘早剥[9.9％(13/131)与4.2％(24/572)]、心功能衰竭[11.5％ (15/131)与3.2％ (18/572)]、肺水肿[4.6％(6/131)与0.9％(5/572)]、产后出血[16.0％(21/131)与7.0％ (40/572)]、子宫胎盘卒中[5.3％(4/131)与0.5％(3/572)]发生率比较,双胎组均高于单胎组(x2=7.013、16.430、9.505、10.990和17.650,P均＜0.01).双胎组与单胎组早产率[77.1％ (202/262)与29.9％(171/572)]、新生儿HIE发生率[8.4％(22/262)与4.7％(27/572)]、新生儿NICU转入率[76.2％(205/262)与58.4％(332/572)]比较,双胎组均高于单胎组(x2=162.000、4.392和31.980,P均＜0.05).结论 双胎妊娠较单胎妊娠更易发生重度子痫前期,且更易发生严重并发症,导致围产儿不良结局.临床应重视双胎妊娠的管理,一旦发生妊娠期高血压疾病应积极治疗并预防并发症,根据病情适时终止妊娠.
    목적 탐토쌍태임신병발중도자간전기잉산부적림상특점급기임신결국.방법 연구대상위2007년6월지2011년6월기간,사천대학화서제이의원수치적703례중도자간전기병례,기중쌍태임신131례,단태임신572례.채용회고성분석적방법,비교쌍태조화단태조잉부적년령、규률산검차수、발병잉주、분면잉주、평균연장잉령、혈압치급실험실검측결과등림상지표,비교태반조박、산후출혈、자궁태반졸중、자간、HELLP종합정(hemolysis,elevated liver enzymes,and low platelets syndrome)등산과병발증,이급심공능쇠갈、폐수종、저단백혈증、시망막병변、로내출혈화신공능불전등병발증발생정황.비교쌍태조화단태조위산인적결국,포괄조산솔、위산인사망솔、신생인중증감호실(neonatal intensive care unit,NICU)전입솔,이급태인군박、신생인결혈결양성뇌병(hypoxie ischemic encephalopathy,HIE)、신생인질식、폐염、고담홍소혈증화저혈당등질병적발생솔.채용t검험、x2검험、교정사격표적x2검험혹Fisher정학개솔법진행통계학분석.결과 쌍태조중도자간전기발병솔고우단태조[5.03％(131/2604)여1.94％(572/29 452),x2=106.40,P＜0.001].쌍태조화단태조적평균발병잉주분별위(33.6±1.8)주화(34.4±2.0)주,평균분면잉주분별위(34.6±2.9)주화(35.6±3.2)주,평균연장잉령분별위(6.4±0.3)d화(7.4±0.5)d,쌍태조균조우단태조(t=2.364、3.902화5.314,P균＜0.05).쌍태조여단태조태반조박[9.9％(13/131)여4.2％(24/572)]、심공능쇠갈[11.5％ (15/131)여3.2％ (18/572)]、폐수종[4.6％(6/131)여0.9％(5/572)]、산후출혈[16.0％(21/131)여7.0％ (40/572)]、자궁태반졸중[5.3％(4/131)여0.5％(3/572)]발생솔비교,쌍태조균고우단태조(x2=7.013、16.430、9.505、10.990화17.650,P균＜0.01).쌍태조여단태조조산솔[77.1％ (202/262)여29.9％(171/572)]、신생인HIE발생솔[8.4％(22/262)여4.7％(27/572)]、신생인NICU전입솔[76.2％(205/262)여58.4％(332/572)]비교,쌍태조균고우단태조(x2=162.000、4.392화31.980,P균＜0.05).결론 쌍태임신교단태임신경역발생중도자간전기,차경역발생엄중병발증,도치위산인불량결국.림상응중시쌍태임신적관리,일단발생임신기고혈압질병응적겁치료병예방병발증,근거병정괄시종지임신.
    Objective To explore the clinical characteristics and pregnancy outcomes of twin pregnancies complicated with severe preeclampsia.Methods The pregnant outcomes of 131 twin pregnancies (twin group) and 572 singleton pregnancies (singleton group),all complicated with severe preeclampsia,were analyzed retrospectively.All patients were treated in the Department of Obstetrics and Gynecology,West China Second University Hospital,Sichuan University from June 2007 to June 2011.The patients' age,onset of disease,gestational weeks at delivery,mean duration of expectant treatment,blood pressure,laboratory parameters and incidence of pregnancy complications,including placental abruption,heart failure,pulmonary edema,postpartum hemorrhage,uteroplacental apoplexy,eclampsia,HELLP syndrome (hemolysis,elevated liver enzymes and low platelets syndrome),hypoproteinemia,retinopathy,intracranial hemorrhage and renal insufficiency,were compared between the two groups.Perinatal outcomes such as premature delivery,perinatal mortality,neonatal intensive care unit (NICU) hospitalization,fetal distress,hypoxic-ischemic encephalopathy (HIE),asphyxia neonatorum,neonatal pneumonia,hyperbilirubinemia and neonatal hypoglycemia of two groups were also compared.Chi-square test,Fisher's exact test or t-test were used for statistical analysis.Results The severe preeclampsia incidence of twin pregnancies (5.03％,131/2604) was higher than that (1.94％,572/29 452) of singleton pregnancy (x2=106.40,P＜0.001).The onset time [(33.6±1.8) weeks] and gestations at delivery [(34.6±2.9) weeks] in twin group were earlier than those in singleton group [(34.4± 2.0) weeks,t=2.364,P＜0.05; (35.6±3.2) weeks,t=3.902,P＜0.05].The duration of expectant treatment of twin group [(6.4±0.3) d] were shorter than that of singleton group [(7.4± 0.5) d,t=5.314,P＜0.01].The incidence of placental abruption [9.9％ (13/131) vs 4.2％ (24/572),x2=7.013,P＜0.01],heart failure [11.5％ (15/131) vs 3.2％ (18/572),x2=16.430,P＜0.01],pulmonary edema [4.6％ (6/131) vs 0.9％ (5/572),x2=9.505,P＜0.01],postpartum hemorrhage [16.0％ (21/131) vs 7.0％ (40/572),x2 =10.990,P ＜ 0.01] and uteroplacental apoplexy [5.3％ (7/131) vs 0.5％ (3/572),x2 =17.650,P＜0.01] of twin group were higher than those of singleton group,respectively.The incidence of premature delivery [77.1％ (202/262) vs 29.9％ (171/572),x2=162.000,P＜0.05],NICU hospitalization [76.2％ (205/262) vs 58.4％(332/572),x2 =31.980,P＜0.05] and HIE [8.4％ (22/262) vs 4.7％ (27/572),x2 =4.392,P＜0.05] of twin group were higher than those of singleton group,respectively.Conclusions Twin pregnancy women are more likely to be complicated with severe preeclampsia and more vulnerable to suffer from severe complications,resulting in poor perinatal outcomes.More attentions should be paid on the management of twin pregnancy.Once hypertensive disorders complicating pregnancy is diagnosed,active management should be provided and timing of termination should be considered.
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