重度子痫前期血小板减少对母儿预后的影响

Perinatal outcomes in severe preeclampsia with thrombocytopenia

目的:探讨重度子痫前期患者血小板减少的母儿预后。方法:按血小板记数分为≥10×109/L组和<10×109/L组,回顾性分析229例重度子痫前期患者的围产期结局。结果:两组间比较,<10×109/L组患者收缩压及舒张压显著高于≥10×109/L组(P均<0.05)。AST、ALT、LDH两组间比较有显著差异(P均<0.05)。临床严重并发症方面,<10×109/L组在弥散性血管内凝血(DIC)、急性肾功能衰竭的发病率较≥10×109/L组显著增高(P均<0.05),而在产后出血、子痫、胎盘早剥、心功能不全、肺水肿、腹水的发病率及剖宫产率的比较均无显著性差异(P均>0.05),但产后出血量<10×109/L组较≥10×109/L组显著增多(P<0.05)。两组在新生儿出生体重、1minApgar评分<7分的新生儿发生率、极低体重儿率及围产儿死亡率的比较均无显著性差异。结论:重度子痫前期合并血小板减少影响患者的预后,但未发现与围产儿结局有关。

Objective： To determine whether thrombocytopenia in pre - eclampsia is associated with maternal and neonate＇s outcomes. Methods： Two hundred and twenty - nine severe pre - eclarnpsia patients were retrospectively analysed, according to the platelet count, the cases were divided into the low platelet count group （ 〈 10 × 10^9/L,n=60） and the normal platelet count group （ ≥10× 10^9/ L, n = 169）. Maternal and perinatal outcomes were compared between the two groups. Statistical annlysis was performed by the student t test and the chi square test. Results： Both systolic pressure and diastolic pressure in the low platelet count group were significantly higher than in the normal platelet count group （P 〈 0. 05）. There were also significant differences between the two groups with regard to aspartate aminotransferase （ AST）, alanine aminotransferase （ALT） and lactate dehydrogenase （LDH） （ Pall 〈 0. 05 ）, respectively. The incidences of acute renal failure and disseminated intravascular coagulation （DIC） were significantly higher in the low platelet count group than those in the normal platelet count group （Pall 〈 0. 05 ）. But no significant differences were found between the two groups with respect to the incidence of postpartum hemorrage, eclampsin, placental abruption, heart failure, pulmonary edema, ascites, heart failure and cesarean rate （Pall 〉 0. 05 ）. However postpartum blood loss in the low platelet count group was much larger than that in the normal platelet count group （P〈0. 05）. Two groups in neonate~ birth weight, the incidence of Apger score 〈7 in 1 minute, the incidence of very low birth weight infant and perinatal mortality had no significant differences. Conclusion： Thrombocytopeoia in pre - eclampsia maybe result in the poor maternal neonate＇s prognosis.