早发型重度子痫前期期待治疗的临床探讨

Clinical approach of expectant management of early-onset severe preeclampsia

目的探讨期待治疗对不同孕周早发型重度子痫前期母儿结局的影响。方法选择2000年3月至2008年3月收治的早发型重度子痫前期患者74例行期待治疗,胎儿及其新生儿80例。根据发病孕周不同分为3组:A组15例(孕周<28周),双胎1例;B组28例(28周≤孕周<32周),双胎2例;C组31例(32周≤孕周<34周),双胎3例。比较各组期待治疗孕产妇及围产儿并发症的发生情况。结果(1)孕妇并发症发生率:A组46.7%,B组42.9%,C组32.3%,3组间比较差异无统计学意义(P>0.05)。(2)胎儿窘迫、胎死宫内、新生儿窒息及新生儿死亡的发生率随孕周增长而下降,差异有统计学意义(P均<0.05)。(3)B组期待治疗时间(16.5±9.4)d显著长于A组(9.8±4.7)d和C组(10.1±8.2)d(P<0.05)。终止妊娠孕周A组(28.9±2.6)周,B组(32.8±2.3)周,C组(34.2±1.2)周,3组间比较差异有统计学意义(P<0.05)。剖宫产率比较,A组93.3%,B组96.4%,C组93.5%,3组间比较差异无统计学意义(P>0.05)。结论早发型重度子痫前期严重影响母婴预后,适当期限的期待治疗可以改善母婴结局,剖宫产仍是终止重度子痫前期的主要方法。

Objective To explore the effect of expectant management on early-onset severe preeclampsia of different gestational weeks. Methods From March 2000 to March 2008, 74 patients with early-onset severe preeclarnpsia were treated by expectant management （ fetus/ newborn infant was 80 cases）. Seventy-four patients were divided into 3 groups by gestational age： 〈28 weeks were belonged to group A （ 15 cases ）, of the total, one patient produced twins; patients of ≥28 weeks and 〈32 weeks were in group B（28 cases） ,2 out of 28 patients gave birth to twins; of ≥ 32 weeks and 〈 34 weeks were in group C （31 cases）, among them,3 patients produced twins. Complications of pregnant women and fetus and infants, time of pregnancy termination, expectant management and rate of cesarean section were compared in 3 groups. Resuits The rates of complications of pregnant women in 3 groups were46.7%（groupA）,42.9%（groupB） and 32. 3% （ group C） respectively （P 〉 0. 05 ）. The rates of fetal distress, dead fetus in uterus, asphyxia neonatorum and neonatal death decreased with increasing of gastational age, the differences among 3 groups were obvious （ all P 〈 0. 05 ）. Time of expectant managemant was （ 16. 5 ± 9. 4） d in group B which was longer than that of group A [ （ 9. 8 ± 4. 7 ） d） and group C [ （ 10. 1 ± 8.2 ） d ] （ P 〈 0. 05 ）. The rates of cesarean section in group A, B and C were 93.3 %, 96.4% and 93.5 % respectively （ P 〉 0. 05 ）. Conclusions Early-onset severe preeolampsia affects acutely maternal and neonatal prognosis. Expectant management of appropriate time limit could improve maternal and neonatal outcomes. Cesarean section is the major method of termination of severe preeclampsia.