南昌大学学报（医学版）
南昌大學學報（醫學版）
남창대학학보（의학판）
ACTA ACADEMIAE MEDICINAE JIANGXI
2015年
2期
32-37
,共6页
肖雪%周燕媚%孙雯%杜培丽%张慧丽%陈敦金
肖雪%週燕媚%孫雯%杜培麗%張慧麗%陳敦金
초설%주연미%손문%두배려%장혜려%진돈금
早发型重度子痫前期%孕产妇并发症%围产儿结局%风险因素
早髮型重度子癇前期%孕產婦併髮癥%圍產兒結跼%風險因素
조발형중도자간전기%잉산부병발증%위산인결국%풍험인소
early onset severe preeclampsia%maternal complications%perinatal outcome%risk factors
目的：探讨早发型重度子痫前期（early onset severe preeclampsia，EOSP）诊断孕周对孕产妇及其围产儿结局影响的临床风险因素。方法将356例重度子痫前期孕产妇按诊断孕周分为3组：＜32孕周 EOSP 组（A 组）154例、32～34孕周 EOSP 组（B 组）50例和＞34孕周 SP 组（C 组）152例。采集3组的人口统计学特征、孕产妇并发症、分娩方式、实验室检查及围产儿结局等临床信息，进行回顾性分析。结果A 组的以往子痫前期病史比例和入院时收缩压／舒张压值数值显著高于 B 组和 C 组（P ＜0．05）；A 组的规范产检比例低于 B 组和 C 组，且与 C 组差异有统计学意义（P ＜0．05）。在24 h 尿蛋白总量、入院时舒张压和缓解病情所需住院治疗时间的比较中，A 组和 B组与 C 组比较差异有统计学意义（P ＜0．01）。A 组、B 组的总临床并发症、肝功能损害、肾功能损害与 C 组比较，差异有统计学意义（P ＜0．05）。A 组的胎盘早剥发生率与 C 组比较差异有统计学意义（P ＜0．05）。单因素分析显示，发病孕周、24 h 尿蛋白水平、双胎妊娠、三胎妊娠、产前检查次数均为早发型重度子痫前期孕产妇住院时间延长的风险因素。A 组患者的胎儿引产率和新生儿死亡率与 B 组、C 组相比差异有统计学意义（P ＜0．05）。死胎、新生儿窒息的发生率 A、B、C 3组间差异均有统计学意义（P ＜0．05）。围产儿死亡相关因素中 OR 值＜1的有：孕产妇发病孕周、住院时间和孕产妇规范产前检查次数；OR 值＞1的有：孕产妇并发肾功能衰竭、并发胎盘早剥和并发心功能不全，差异均有统计学意义（P ＜0．05）。结论EOSP 发病孕周＜32周具有病情重、并发症多、孕产妇及围产儿不良预后发生率高的特点。因此，提前2周诊断 EOSP，即以＜32孕周划分 EOSP，对及时治疗重度子痫前期尤其是早发性重度子痫前期孕产妇、减少或延迟并发症的发生、最大限度降低孕产妇及围产儿不良结局的发生弥足珍贵。
目的：探討早髮型重度子癇前期（early onset severe preeclampsia，EOSP）診斷孕週對孕產婦及其圍產兒結跼影響的臨床風險因素。方法將356例重度子癇前期孕產婦按診斷孕週分為3組：＜32孕週 EOSP 組（A 組）154例、32～34孕週 EOSP 組（B 組）50例和＞34孕週 SP 組（C 組）152例。採集3組的人口統計學特徵、孕產婦併髮癥、分娩方式、實驗室檢查及圍產兒結跼等臨床信息，進行迴顧性分析。結果A 組的以往子癇前期病史比例和入院時收縮壓／舒張壓值數值顯著高于 B 組和 C 組（P ＜0．05）；A 組的規範產檢比例低于 B 組和 C 組，且與 C 組差異有統計學意義（P ＜0．05）。在24 h 尿蛋白總量、入院時舒張壓和緩解病情所需住院治療時間的比較中，A 組和 B組與 C 組比較差異有統計學意義（P ＜0．01）。A 組、B 組的總臨床併髮癥、肝功能損害、腎功能損害與 C 組比較，差異有統計學意義（P ＜0．05）。A 組的胎盤早剝髮生率與 C 組比較差異有統計學意義（P ＜0．05）。單因素分析顯示，髮病孕週、24 h 尿蛋白水平、雙胎妊娠、三胎妊娠、產前檢查次數均為早髮型重度子癇前期孕產婦住院時間延長的風險因素。A 組患者的胎兒引產率和新生兒死亡率與 B 組、C 組相比差異有統計學意義（P ＜0．05）。死胎、新生兒窒息的髮生率 A、B、C 3組間差異均有統計學意義（P ＜0．05）。圍產兒死亡相關因素中 OR 值＜1的有：孕產婦髮病孕週、住院時間和孕產婦規範產前檢查次數；OR 值＞1的有：孕產婦併髮腎功能衰竭、併髮胎盤早剝和併髮心功能不全，差異均有統計學意義（P ＜0．05）。結論EOSP 髮病孕週＜32週具有病情重、併髮癥多、孕產婦及圍產兒不良預後髮生率高的特點。因此，提前2週診斷 EOSP，即以＜32孕週劃分 EOSP，對及時治療重度子癇前期尤其是早髮性重度子癇前期孕產婦、減少或延遲併髮癥的髮生、最大限度降低孕產婦及圍產兒不良結跼的髮生瀰足珍貴。
목적：탐토조발형중도자간전기（early onset severe preeclampsia，EOSP）진단잉주대잉산부급기위산인결국영향적림상풍험인소。방법장356례중도자간전기잉산부안진단잉주분위3조：＜32잉주 EOSP 조（A 조）154례、32～34잉주 EOSP 조（B 조）50례화＞34잉주 SP 조（C 조）152례。채집3조적인구통계학특정、잉산부병발증、분면방식、실험실검사급위산인결국등림상신식，진행회고성분석。결과A 조적이왕자간전기병사비례화입원시수축압／서장압치수치현저고우 B 조화 C 조（P ＜0．05）；A 조적규범산검비례저우 B 조화 C 조，차여 C 조차이유통계학의의（P ＜0．05）。재24 h 뇨단백총량、입원시서장압화완해병정소수주원치료시간적비교중，A 조화 B조여 C 조비교차이유통계학의의（P ＜0．01）。A 조、B 조적총림상병발증、간공능손해、신공능손해여 C 조비교，차이유통계학의의（P ＜0．05）。A 조적태반조박발생솔여 C 조비교차이유통계학의의（P ＜0．05）。단인소분석현시，발병잉주、24 h 뇨단백수평、쌍태임신、삼태임신、산전검사차수균위조발형중도자간전기잉산부주원시간연장적풍험인소。A 조환자적태인인산솔화신생인사망솔여 B 조、C 조상비차이유통계학의의（P ＜0．05）。사태、신생인질식적발생솔 A、B、C 3조간차이균유통계학의의（P ＜0．05）。위산인사망상관인소중 OR 치＜1적유：잉산부발병잉주、주원시간화잉산부규범산전검사차수；OR 치＞1적유：잉산부병발신공능쇠갈、병발태반조박화병발심공능불전，차이균유통계학의의（P ＜0．05）。결론EOSP 발병잉주＜32주구유병정중、병발증다、잉산부급위산인불량예후발생솔고적특점。인차，제전2주진단 EOSP，즉이＜32잉주화분 EOSP，대급시치료중도자간전기우기시조발성중도자간전기잉산부、감소혹연지병발증적발생、최대한도강저잉산부급위산인불량결국적발생미족진귀。
ABSTRACT:Objective To investigate the effects of gestational age at diagnosis of early onset se-vere preeclampsia (EOSP)on maternal and perinatal outcomes.Methods A total of 356 women with severe preeclampsia(SP)were divided into three groups according to the gestational age at diagnosis:<32 weeks (group A,n=154),32-34 weeks (group B,n=50),and >34 weeks (group C,n= 152).Clinical data regarding demographic characteristics,maternal complications,delivery modes,laboratory tests and perinatal outcomes were analyzed retrospectively.Results Compared with group B or C,the percentage of women with a previous history of preeclampsia and the sys-tolic/diastolic blood pressure on admission significantly increased in group A (P < 0.05).The percentage of women who received standard antenatal care in group A was lower than that in group B,and was significantly lower than that in group C (P <0.05).The 24-hour urine protein excretion,diastolic blood pressure on admission,time required to alleviate the illness condition and incidences of overall complications,liver damage and renal dysfunction in group C were signifi-cantly different from those in group A and B (P <0.05 or P <0.01).Furthermore,the difference in the incidence of placental abruption was significant between group A and group C (P <0.05). Univariate analysis showed that gestational age at onset,24-hour urine protein excretion,twin pregnancy,triplet pregnancy and number of antenatal care visits were the risk factors for pro-longed hospital stay in women with EOSP.The incidences of abortion and neonatal death in group A were significantly different from those in group B and C (P <0.05).However,the incidences of stillbirth and neonatal asphyxia were significantly different among the three groups (P <0.05). The perinatal death-related factors included gestational age at onset (OR<1),length of hospital stay (OR<1),number of standard antenatal care visits (OR<1),renal failure (OR>1),placental abruption (OR>1),and cardiac insufficiency (OR>1)(P <0.05).Conclusion The EOSP with an onset before 32 weeks of gestation is associated with severer condition,more complications,and higher incidence of poor maternal and perinatal outcomes.Therefore,EOSP should be diagnosed 2 weeks in advance (gestational age < 32 weeks at diagnosis)to timely treat severe preeclampsia (especially EOSP),reduce or delay the occurrence of complication,and minimize poor maternal and perinatal outcomes.
