妊娠合并急性肾功能衰竭36例临床分析

Clinical analysis of 36 pregnancies complicated with acute renal failure

目的 探讨妊娠合并急性肾功能衰竭（acute renal failure，ARF）的病因、发病特点、临床转归及防治措施。方法 对我院1996年3月至2005年3月间36例妊娠合并ARF的病例进行回顾性分析。结果妊娠合并ARF的病因：妊娠早期为感染性流产或引产、妊娠剧吐；妊娠后期多为妊娠期高血压疾病、胎盘早剥、羊水栓塞、妊娠期急性脂肪肝、HELLP综合征等；产后则为特发性产后肾功能衰竭。发病特点为发病急、进展迅速，可造成不可逆的肾功能损伤，甚至引起多器官衰竭。妊娠合并ARF的孕产妇、围产儿死亡率分别为19．4％（7／36）和30．3％（10／33）。血液透析治疗组多器官衰竭发生率和孕产妇死亡率均显著低于综合治疗组。结论妊娠合并ARF的病因多种多样，及时治疗原发病，防止并发症，尽早透析治疗，可提高ARF抢救成功率，减少多器官衰竭发生率，降低孕产妇及围产儿死亡率。

Objective To explore the etiology, characterstics of pathogenesis, clinical outcomes and prevention and management of pregnancy complicated acute renal failure（ARF）. Methods The data of 36 cases with ARF during pregnancy in the Nanfang Hospital of Nanfang Medical University from 1996 to 2005 were analyzed retrospectively. Results The etiology of pregnancy complicated ARF were septic abortion or termination of told-pregnancy, hyperemesis gravidarum during early pregnancy and hypertensive disorders complicated pregnancy, placental abruption, amniotic fluid embolism, acute fatty liver of pregnancy, HELLP syndrome etc. during late pregnancy. While idio pathic renal failure occurred after delivery. The incidence of ARF during pregnancy was 0. 285 ~. The maternal mortality rate and perlnatal mortality rate in pregnant women with ARF were 19.4 %（7/36） and 30. 3% （10/33）, respectively. The incidence of multiple organ dysfunction syndrome and death rate in pregnant women with ARF in the hemodialysis group was lower than that in comprehensive treatment group. Conclusions Pregnancy complicated ARF is caused by various factors and characterized by rapid development and adverse prognosis. It is necessary to treat the underlying diseases to prevent the occurrence of ARK Early hemodlalysis could improve the prognosis of the pregnant women with ARF and reduce the maternal and perinatal mortality rate.