妊娠肝内胆汁淤积症的临床分析及护理

Clinical Care for Intrahepatic Cholestasis of Pregnancy

目的探讨妊娠合并肝内胆汁淤积症(ICP)的临床发病特点及表现,采取健康教育,护理干预措施后对妊娠结局的影响。方法对2005年1月-2007年12月收治的116例妊娠合并肝内胆汁淤积症的孕妇资料按2005年-2006年53例为对照组、2007年63例为观察组进行回顾性的分析统计;通过观察及护理比较两组间妊娠结局及护理效果。结果①两组ICP的孕妇皮肤瘙痒112例﹙96.55%﹚,ALT、AST升高107例﹙92.24%﹚,TBA116例均升高﹙100%﹚;②观察组通过系统的健康教育,提高ICP孕妇战胜疾病的信心,主动积极的配合临床治疗和护理干预措施。胎儿宫内窘迫率,新生儿窒息率,产后出血率,比对照组显著降低(P〈0.01)。观察组早产率高于对照组是由于采取干预早产,死胎率、剖宫产率无差异。结论皮肤瘙痒是ICP首发症状,TBA升高是特异性证据;ICP对母婴的危害较大,通过强化健康教育,加强孕期保健和自我监护,辅以必要的药物治疗和切实可行的护理措施,ICP孕妇能够有较为满意的妊娠结局,剖宫产是目前终止ICP妊娠的重要手段。

Objective The objective is to discuss the clinical symptoms and manifestation of intrahepatic cholestasis of pregnancy （ICP）, and the influence of final ending of pregnancy after taking health education and nursing intervention. Method We carried on retrospective analytic statistics to the data of 116 patients of ICP, whom were divided into two parts by admission dates, 53 patients as contrast group from 2005 to 2006, and the rest 63 as observation group from 2007, and compared the final ending of pregnancy and nursing result between the two groups by contrasting and nursing. Result （1） There were 112 cases （96.55%） who had cutaneous pruritus, 107 cases （96.24%） who has elevation of ALT and AST, 116 cases （1100%） elevation of TBA; （2） After the systemic health education, the contrast group became more confident of surmounting diseases, and worked in conjunction with clinical remedy and nursing intervention. And they also had lower proportions （P〈0.01） of fetal distress, fetal asphyxia, and postpartum hemorrhage. The reason of the contrast group had a higher premature delivery is the acceptance of intervening premature delivery, while the two groups had the same proportions of late foetal death and cesarean section. Conclusion The early symptom of ICP is cutaneous pruritus, and the specificity proof is the elevation of TBA. ICP is some severely pernicious to both mother and infant. Patients of ICP can get a satisfying result of pregnancy through intensifying health education, antenatal care and self-wardship, moreover, by means of necessary medication and operable nursing. Cesarean section is a significant method to stop ICP.