高龄初产妇并发妊高征的临床分析

The clinic analysis of elderly primipara complicated by pregnancy induced hypertension

目的 :探讨改善高龄初产妇并发妊高征患者的母儿预后的途径。方法 :回顾性分析 2 0 0 1年 12月～ 2 0 0 3年 12月3 3例高龄初产妇并发妊高征患者 (观察组 )的母儿预后及影响母儿预后的因素 ,以同期分娩的 2 3 0例正常生育年龄初产妇并发妊高征患者 (对照组 )进行对照。结果 :观察组轻、中、重度妊高征、子痫的发生率与对照组比较差异无显著性 (P >0 0 5 )。观察组定期产前检查率比对照组高 (P <0 0 5 )。观察组心衰、肝损害、肾损害、胎盘早剥、弥漫性血管内凝血、HELLP综合征等严重并发症的发生率与对照组比较无显著性差异 (P >0 0 5 )。观察组胎儿宫内发育迟缓的发生率比对照组高 ,差异有显著性(P <0 0 5 )。新生儿窒息、胎儿宫内窘迫、围产儿死亡、早产的发生率两组比较 ,差异无显著性 (P >0 0 5 )。两组剖宫产率比较 ,差异无显著性 (P >0 0 5 )。病程超过 4周的高龄初产妇并发妊高征患者的重度妊高征发生率及围产儿死亡率比病程短于 4周的患者高 (P <0 0 5 )。结论 :定期产前检查 ,适时住院治疗 ,对病程超过 4周的高龄初产妇并发妊高征患者加强监护 ,适当提前终止妊娠、择期剖宫产对改善高龄初产妇并发妊高征患者的母儿结局具有重要意义。

Objective:To study the ways to improve the prognosis of elderly primipara complicated pregnancy induced hypertension ( PIH ) .Methods:The restropective analysis about 33 cases elderly primipara with PIH and the factors of affecting the prognosis was made.The nomal childbearing age primipara with PIH was chosen as a control group .Results:The rates of mild PIH , moderate PIH , serious PIH and eclampsia between the observed group and the control group were no significant different (P>0.05 ).The number of regularity prenatal check-up in observed group was more than in that in control group ( P<0.05 ). The mean prenatal hospitalization was longer in observed group than in control group ( P<0.05 ). The rates of failure ,kidney failure ,liver damaged ,eye ground bleeding ,placenta abruption ,disseminated intravascular coagulation ( DIC ) and HELLP syndromes were no significant different in observed group and control group .The rate of intrauterine growth retardation in observed group was higher than that in control group (P<0.05 ); there were no significant difference between the two groups in rates of asphyxia neonatorum , intrauterine fetal anoxia ,perinatal mortality and premature (P>0.05 ). The rates of cesarean section were no different between the two groups ( P>0.05 ).With the observed group , the rates of serious PIH and perinatal mortality were higher when the course of disease were above four weeks than within four weeks .Conclusion:Prenatal check-up regularity , hospitalization in time ,making the labor ahead properly to the patients whose course of disease were above four weeks and elective section deliver were very important to improve the prognosis of the elderly primipara complicated PIH and their perinatal .