妊娠合并重型肝炎患者MELD评分分析与终止妊娠时机

Analysis of MELD score and termination of pregnancy for pregnancy combined with serious hepatitis

目的根据MELD评分分析,研究妊娠合并重型肝炎患者终止妊娠的最佳时机。方法回顾性分析我院2004年1月—2008年12月36例妊娠合并重型肝炎住院患者的临床资料,以生存组和死亡组划分,计算MELD分值;分析比较2组患者入院时、终止妊娠时MELD分值、△MELD值的变化及与病死率的关系。结果死亡组患者入院时MELD值为27.8±8.96,△MELD值为4.1±3.99;存活组入院时MELD值为22.9±9.97,△MELD值为-0.99±4.2;2组间有显著性差异(P<0.05);MELD值<20,患者病死率为5.9%;20≤MELD值≤30,病死率为28.9%;MELD值>30,病死率为78.1%,各组间病死率比较均有显著性差异(P均<0.05)。结论MELD分值越高患者的病死率越高。MELD评分可以作为评估妊娠合并重型肝炎患者存活的指标,便于产科医生迅速做出是否需要终止妊娠的判断标准。

Objective It is to study the best opportunity of termination of pregnancy in patient with pregnancy combined with serious hepatitis according to analysis of MELD score. Methods 36 cases clinical data from January 2004 to December 2008 of serious hepatitis in pregnancy was retrospectively analyzed. The patients were divided into survival group and death group. The MELD score was calculated. The changes of MELD score and AMELD score in the two groups on admission and on termination of pregnancy and the relationship between the changes with mortality were analyzed and compared. Results The MELD score and AMELD score on admission in death group was respectively 27.8±8.96 and 4. 1 ± 3.99 and that in survival group was respectively 22.9 ± 9.97 and 0.99 ±4.2, and there were significant differences between the two groups （ P 〈 0.05）. The mortality was respectively 5.9 %, 28.9 % and 78.1% when MELD score was respectively in 〈 20, 20 to 30 and 〉30, and there were significant difference among the three groups （all P 〈 0.05）. Conclusion The higher MELD score, the higher mortality. MELD score can be used as a standard for evaluation of survival in patients with pregnancy combined with serious hepatitis in order to make rapid decision for obstetrician.