重度子痫前期终止妊娠时间对母儿预后的影响

Maternal and perinatal prognosis determined by the time of pregnancy termination in severe preeclampsia

目的探讨重度子痫前期患者终止妊娠时间对母儿预后的影响。方法回顾分析2000年1月～2007年12月，我院妇产科收治的92例重度子痫前期患者的资料，按入院确诊至终止妊娠的时间分为三组。A组：确诊后24h终止妊娠，B组：确诊后24～48h终止妊娠，C组：确诊后〉48h终止妊娠。对三组患者母儿预后进行分析。结果（1）三组患者实验室检查均提示有凝血功能及肝肾功能障碍，三组患者间终止妊娠前低蛋白血征及蛋白尿发生率比较差异有显著性意义（P〈0．05）。（2）C组患者HELLP综合征发生率低，与其他两组比较差异有显著性意义（P〈0．05）。（3）三组围生儿结局比较，C组胎儿生长受限（FGR）及早产儿发生率最高，分别是48．6％和68．6％。（4）三组间分娩方式的比较差异有显著性意义（P〈0．05），三组患者剖宫产率均高于阴道分娩率，C组剖宫产率达91．4％。结论重度子痫前期患者应根据病情轻重、发病孕周及胎儿宫内状况采取个体化的治疗方案，选择恰当的时机终止妊娠，能取得较好的母婴结局。保守治疗时应实施严密监护。

Objective To investigate the optimal time of pregnancy termination for patients with severe pre-eclampsia.Methods A total of 92 cases with severe pre-eclampsia admitted into Long Du Hospital from Jan. 2000 to Dec. 2007 were enrolled. They were divided into three groups according to different time spans from confirmed diagnosis to delivery. Group A： within 24 hours; Group B： 24-48 hours; Group C： over 48 hours. Maternal and perinatal prognoses of the three groups were analyzed retrospectively. Results （1） Deficiencies in blood-coagulation and liver-kidney functions were showed obviously in all the three groups and there were no discrepancies among the three groups except for a remarkable difference （P〈0.05） in the occurrence of low proteinumia and albuminuria before the termination of pregnancy. （2） A significant lower incidence of HELLP syndrome occur：ed in Group C than those in Group A and B （P〈0.05）. （3） The incidence of FGR and premature delivery showed obvious difference among the three groups. Mothers in Group C had the highest incidence of FGR （48.6%） and premature delivery （68.6%）. （4） The rate of cesarean section was the highest in Group C, which was 91.4%. Conclusion Individualized treatment should be exercised in treating patients with severe preeclampsia, depending on patients＇physical conditions, gestational ages and fetal states. Pregnancy should be terminated at its optimal time.