子痫前期保守治疗及终止妊娠时间的探讨

Expectant management and gestational age at delivery of pre-eclampsia

目的:探讨子痫前期保守治疗的临床意义及适时终止妊娠的时间。方法:回顾分析2002年1月～2004年8月该院收治的67例子痫前期的临床资料,按其发病孕周分为:A组<32周6例,B组32～33周2例,C组34～36周16例,D组≥37周43例。主要分析指标包括:发病孕周、终止妊娠孕周、孕周延长时间、严重并发症发生情况、胎儿及新生儿死亡率。结果:A组保守治疗时间平均为(46.2±18.2)天,B组为(19.0±7.1)天,C组为(12.2±9.0)天,D组为(5.2±7.8)天,差异有统计学意义(P<0.01)。C、D组并发症发生率的比较,差异无统计学意义(P>0.05),但与A、B组比较,差异有统计学意义(P<0.01)。A组与B、C、D组胎儿及新生儿死亡率的比较,差异有统计学意义(P<0.05)。孕32周前终止妊娠的子痫前期患者胎儿、新生儿死亡率与孕32周后终止妊娠患者比较差异有统计学意义(P<0.05)。结论:子痫前期发病于32周前,孕妇并发症发生率及胎儿、新生儿死亡率高,采取保守治疗至32周甚至34周后,胎儿及新生儿死亡率降低,而孕妇并发症有所上升。故应严格选择病例,并严密监护,适时终止妊娠。

Objective： To investigate the difference of maternal and perinatal outcome with expectant management and gestational age at delivery of pre - eelampsia. Methods： 67 cases meeting pre - eelampsia who underwent expectant management were enrolled in this study. Patients were divided into 4 groups： group A （n = 6） with onset before 32 weeks of gestation, group B （n = 2） with onset during 32 -33 weeks of gestation, group C （n = 16） with onset during 34 -36 weeks of gestation, group D （n =43） with onset ~37 weeks of gestation, Main outcome measures included prolongation of gestation, perinatal mortality rate and major complication. Results： The average pregnancy prolongation was （46. 2 ± 18. 2） days, （ 19.0 ±7. 1 ） days, （ 12. 2 ±9. 0） days, （ 5. 2 ± 7. 8 ） days, respectively in groups A, B , C, D, The onset gestational age and the gestational age at delivery was closely associated with the perlnatal outcome. Perinatal mortality onsetting before 32 weeks of gestation was significantly higher than that onsetting after 32 weeks of gestation. Major complication morbidity onsetting before 34 weeks of gestation was significantly higher than that onsetting before 34 weeks of gestation. Perinatal mortality before 32 weeks of gestational age at delivery was significantly higher than that after 32 weeks of gestational age at delivery. Conclusion： Perinatal mortality and major complication morbidity are significantly higher than that onsetting after 32 weeks of gestation. Expectant management should be carried out to 32 weeks of gestation even 34 weeks in well - selected patients and should be selected reasonable gestational age at delivery.