重度子痫前期并发腹水与妊娠结局的关系

THE RELATIONSHIP BETWEEN SEVERE PREECLAMPSIA COMPLICATED WITH ASCITES AND PREGNANCY OUTCOME

[目的]探讨重度子痫前期并发腹水的临床特点、孕产期处理及母儿预后。[方法]对2005年1月～2007年7月我院59例重度子痫前期并发腹水患者的临床资料进行回顾性分析,并抽取同期103例未并发腹水的重度子痫前期患者作为对照组。[结果]①重度子痫前期并发腹水患者占我院妊娠期高血压疾病人数的11.5%,59例患者均有低蛋白血症,其总蛋白、白蛋白量低于对照组(P﹤0.05),肾功损害亦比后者严重(P﹤0.05)。②51例经剖宫产证实腹水量为300～8000ml,腹水量与孕周无关(P=0.235),B超提示26例患者同时合并有胸水。③并发腹水患者中51例行了剖宫产(86.4%),1例死亡未分娩,余7例经阴道分娩,平均终止妊娠时间为(32.95±3.37)周,早于对照组患者(P=0.000)。④25例孕妇出现严重并发症(42.37%)。FGR发生率高达60.9%,高于对照组患者(χ2=7.177,P=0.005);围产儿平均体重为(1544±537)g,显著低于对照组(P=0.000);死胎和新生儿死亡率达51.6%,高于对照组(P=0.000)。[结论]重度子痫前期并发腹水是疾病发展的严重阶段,发病早,围产儿预后差,孕期应加强母婴监护,合理治疗并适时终止妊娠以改善妊娠结局。

[ Objective] To explore clinical feature, treatment and mothers＇ and children＇s prognosis of severe preeclampsia complicated with ascites. [Methods] The clinical data of 59 cases of severe preeclampsia complicated with ascites and 103 cases of severe preeclampsia without ascites （control group） were analyzed retrospectively. [Results]①The incidence of severe preeclampsia with ascites was 11.5%, 59 patients all had low proteinemia （ 〈 30 g/L）, the maternal serum total protein and albumin were lower than those in control group, and renal function lesion was also relatively severity in patients complicated with ascites （P 〈 0.05）. ②51 cases complicated with aseites, the volumes of aseites were from 300ml to 8000ml proved by cesarean section, which wasn＇t correlated with gestational weeks （P=0.235）, 26 patients combined with pleural effusion proved by B-ultrasound.③51 patients were terminated pregnancy by cesarean section （86.4%）, 1 died and 7 by vaginal delivery, the delivery gestational weeks were 32.95±3.37, which were earlier than that of control group （P=0.000） .④The incidence of serious materual complication was 42.37%.The incidence of fetal growth retardation （FGR） was 60.9%, which was higher than that in control group （X^2= 7.177, P = 0.005）; the birth-weight was significandy lower than that in control group （P=0.000） ; the perinatal mortality was higher than that in control group （P = 0.000）. [Conclusion] Severe preeclampsia complicated with ascites is the severe stage of the disease, which associates with poor pregnancy outcomes. Inten-sive care, proper medical intervention and termination of pregnancy should be recommend to improve pregnancy outcomes at suitable time.