分娩方式对妊娠合并重型肝炎产妇预后的影响

The influence on the prognosis of parturients with hepatitis gravis in pregnancy caused by delivery mode

目的探讨不同分娩方式对妊娠合并重型肝炎产妇预后的影响。方法回顾1994-2007年间60例妊娠合并重型肝炎病例的资料,按分娩方式分为阴道分娩组、剖宫产组以及剖宫产加子宫切除组,其中阴道分娩组22例,剖宫产组20例,剖宫产加子宫切除组18例,对比三组患者分娩前、分娩后的情况及病死率。统计方法采用方差分析,卡方检验、F isher′s精确概率法和秩和检验。结果三组患者分娩前血清胆红素、血清胆固醇、凝血酶原活动度、血清肌酐、血清胆碱酯酶、肝性脑病及肝肾综合征发生情况差别无显著性;分娩后血清胆固醇、血清胆碱酯酶及肝性脑病在各组间差别无显著性;分娩后阴道分娩组与剖宫产组的血清胆红素、凝血酶原活动度、血清肌酐、肝肾综合征、产后出血、产褥感染、病死率差异无显著性,而阴道分娩组或剖宫产组与剖宫产加子宫切除组相比,上述指标差异均有显著性。结论妊娠合并重型肝炎产妇采用剖宫产加子宫切除预后较好。

Objective ： To explore the influence on the prognosis of parturients with hepatitis gravis in pregnancy caused by delivery mode. Methods： 60 cases of hepatitis gravis in pregnancy between 1994 and 2007 were looked back to. They were devided into vaginal＇birth group （22 cases）, caesarean section group （20 cases） and caesarean section plus hysterectomy group （18 cases） based on delivery mode. The situation before and after delivery and the mortality were compared among the three groups using analysis of variance, Chi - sqare test, fisber＇s exact test and rank sum test. Results ： There was no significant difference in serum total bilirubin, serum cholesterol, plasma thromboplastin activity, serum creatine, serum cholinesterase, the incidence of bepato - renal syndrome and hepatic encephalopathy among the three groups before delivery. After delivery there was no significant difference in serum cholesterol, serum cholinesterase, and the incidence of hepatic encephalopathy among the three groups. After delivery there was no significant difference in serum total bilirubin , plasma thromboplastin activity, serum creatine , incidence of bepato - renal syndrome, postpartum hemorrhage, puerperal infection and mortality between vaginal birth group and caesarean section group , but there were both significant difference in all the indexes above between vaginal birth group or caesarean section group and caesarean section plus hysterectomy group. Conclusion ： Caesarean section plus hysterectomy is the better delivery mode for parturients with hepatitis gravis in pregnancy.