614例重度子痫前期母儿妊娠结局的比较分析

Comparison and analysis on the pregnancy outcomes of 614 pregnant women with severe preeclampsia and their neonates

目的:分析重度子痫前期临床特征、妊娠结局及围产儿死亡的预后因素,为提高围产期保健干预提供参考。方法:回顾性分析614例重度子痫前期患者,并根据其发病孕周分为<32周组52例,32～<34周组52例,34～<37周组127例;≥37周组383例。分析患者的一般临床资料、保健情况和妊娠结局,比较产妇并发症及围产儿预后情况。结果:614例重度子痫前期患者中,孕妇死亡2例,子宫切除4例,围产儿总数579例,其中围产儿死亡18例。发病在<32周组和32～<34周组的HELLP综合征、围产儿死亡、出生缺陷、新生儿窒息的比例大于其他两组(P<0.05),而分娩孕周则低于其他两组(P<0.05)。重度子痫前期患者的发病时间与围产儿死亡存在强相关:患者发病孕周<34周的OR值为38.09(1.72～842.86)。结论:34周前发病的重度子痫前期患者容易出现母儿不良预后,且发病越早,母儿预后越差。加强宣教,提高人群的自我保健和及时就诊意识,有利于重度子痫前期早期诊断、早期治疗,减少患者并发症和不良妊娠结局的发生。

Objective：To analyze the clinical characteristics and pregnancy outcomes of severe preeclampsia and the effect factors of prognosis of perinatal mortality,provide a basis for improving the intervention of perinatal health care.Methods：614 cases with severe preeclampsia were analyzed retrospectively,then they were divided into 〈32 weeks group（52 cases）,32～〈34 weeks group（52 cases）,34～〈37 weeks group（127 cases） and ≥37 weeks group（383 cases）.The general clinical data,healthcare conditions and pregnancy outcomes were analyzed,the maternal complications and perinatal prognosis were compared.Results：Among 614 cases with severe preeclampsia,2 cases died,4 cases underwent hysterectomy,the total number of perinatal infants was 579,and 18 perinatal infants died.The incidences of HELLP syndrome,perinatal death,birth defects and neonatal asphyxia in 〈32 weeks group and 32～〈34 weeks group were significantly higher than those in the other two groups（P〈0.05）,while the gestational weeks were lower than those in the other two groups（P〈0.05）.There was positive correlation between onset time of cases with severe preeclampsia and perinatal death,the OR value of onset time〈34 gestational weeks was 38.09（1.72～842.86）.Conclusion：The patients whose onset time of severe preeclampsia is less than 34 gestational weeks are prone to adverse prognosis of mothers and neonates,and the earlier the onset time is,the poorer the prognosis of mothers and neonates is.Enhancing publicity and education,improving the consciousness of self-care and timely treatment are helpful to early diagnosis and early treatment,which may reduce the occurrence of complications and adverse pregnancy outcomes.