早发型重度子痫前期期待治疗的综合权衡

Balanced analysis of expectant treatment of early-onset severe preeclampsia

目的对不同孕周入院的早发型重度子痫前期患者行期待治疗的母儿双方作用进行综合权衡,探讨不同孕周患者行期待治疗时的把握倾向。方法回顾分析我院2008年7月～2011年6月收治的128例早发型重度子痫前期患者临床治疗的情况。按照入院孕周分为三组,A组:<29周27例,B组:29～31+6周49例,C组:32～33+6周52例。比较不同孕周入院患者接受期待治疗至终止妊娠的时长、期间孕产妇并发症的发生情况、围产儿不良结局情况,分析不同孕周患者行期待治疗对母儿状况的正面和负面作用,综合权衡两方。结果三组孕产妇期待治疗至终止妊娠的时长以B组为最长,A组次之,C组最短;A、B组孕妇并发症发生率差异无统计学意义,P>0.05,C组与A、B组差异有统计学意义,P<0.05;三组围产儿结局以C组为最佳,B组次之,A组最差,围产儿不良结局率差异有统计学意义P<0.05。结论经比较权衡不同孕周早发型重度子痫前期患者期待治疗对孕妇造成的负面作用和给围产儿带来的正面效果,不同孕周患者在采取期待治疗时在把握倾向上应有所侧重:对于<29周的患者,负面作用严重时宜倾向于放弃期待治疗;对于>29周的患者,期待治疗的正面效果使得尽可能延长孕周的治疗方案成为相对可取;对于32～34周的患者,主动选择提前终止妊娠的做法使改善围产儿结局的潜力没有得到充分挖掘,在条件允许的情况下,宜于坚持期待治疗直至终止妊娠的客观指征出现。

Objective To analyze both maternal and fetal effects of expectant treatment of early-onset severe preeclamp- sia, and discuss recommendable treatment choices based on the balance of both effects. Methods To review the 128 cases of ear- ly-onset severe preeclamosia treated in our hospital from July 2008 to June 2011, divided into three groups according to gestation weeks when hospitalized： Group A with 27 cases less than 29 weeks, Group B with 49 cases of 29 -31 ＋6 weeks, Group C with 52 cases of 32 - 34 weeks. Results Group B had the longest average treatment time while Group A shorter and Group C the shor- test; pregnancy complieations ratio of Group C is significandy different （P 〈 0. 05 ） from Groups A and B, whereas no significant difference （ P 〉 0.05 ） between Groups A and B ; and the poor perinatal outcome ratios are significantly different （ P 〈 0. 05 ） a- mong the three groups, with Group C the best and Group B poorer and Group A the poorest. Conclusion On balanced considera- tion, patients of less than 29 gestation weeks, when afflicted with pregnancy complications, might advisably choose to terminate pregnancy, while those of 29 -31 ＋6 weeks might choose to stay on expectant treatment for longer gestation time and better perina- tat outcome, mnd those of 32 - 34 weeks should make more efforts to prolong gestation time to further improve the perinatal out- come.