慢性高血压并发早发型重度先兆子痫单胎孕妇围产期母儿结局的回顾性分析

Retrospective analysis of perinatal outcomes of singleton pregnant women with early-onset severe preeclampsia superimposed on chronic hypertension

目的探讨慢性高血压并发早发型重度先兆子痫较单纯早发型重度先兆子痫是否会增加母儿的不良结局。方法自1999年7月1日至2009年6月30日北京大学第一医院共收治早发型重度先兆子痫单胎孕妇300例,其中慢性高血压并发早发型重度先兆子痫者59例(A组),单纯早发型重度先兆子痫者241例(B组),对两组孕妇的母儿结局进行分析,讨论慢性高血压并发早发型重度先兆子痫是否会增加母儿的不良结局。结果两组孕妇一般情况没有明显的差异,A组的最高收缩压和舒张压明显高于B组(P<0.05)。两组孕妇严重并发症如胎盘早剥、HELLP综合征、肺水肿、肝功能损害和子痫等发生率比较,差异无统计学意义(P>0.05)。A组除了新生儿呼吸窘迫综合征的发生率明显高于B组外(P<0.05),两组围产儿死亡率、胎儿生长受限、新生儿窒息、颅内出血和坏死性小肠结肠炎的发生率比较,差异无统计学意义(P>0.05)。结论在病情允许的情况下,通过严密监测母儿一般状况、积极地对症治疗并采用适当的期待疗法,慢性高血压并发早发型重度先兆子痫较单纯早发型重度先兆子痫没有对母儿造成明显的不良后果。

Objective To explore whether early-onset severe preeclampsia superimposed on chronic hypertension would bring more adverse maternal neonatal outcomes compared with isolated early-onset severe preeclampsia.Methods Totally 300 singleton pregnant women with early-onset severe preeclampsia who were treated in Peking University First Hospital from July 1th,1999 to June 30th,2009 were identified and divided into two groups：early-onset severe preeclampsia superimposed on chronic hypertension（group A,n=59）and isolated early-onset severe preeclampsia（group B,n=241）.The maternal and fetal outcomes of all subjects were collected and analyzed.Results There was no significant differences between the two groups in baseline information.However,the highest systolic and diastolic blood pressure in group A were significantly higher than those in group B（P0.05）.The incidence of serious maternal complications,such as placental abruption,HELLP syndrome,pulmonary edema,liver damage and eclampsia,showed no difference between the two groups（P0.05）,the incidence of the perinatal mortality,fetal growth restriction,neonatal asphyxia,intracranial hemorrhage and necrotizing enterocolitis dinn＇t showed any significant differences either（P0.05）,except for higher rate of neonatal respiratory distress syndrome in group A than in Group B（P0.05）.Conclusions Compared with isolated early-onset severe preeclampsia,the early-onset severe preeclampsia superimposed on chronic hypertension do not worsen the maternal and fetal outcomes under,monitoring to the mothers and fetuses and aggressive symptomatic treatment with appropriate expectant management.