131例双胎妊娠并发重度子痫前期的妊娠结局

Pregnancy outcomes of 131 twin pregnancies complicated with severe preeclampsia

目的探讨双胎妊娠并发重度子痫前期孕产妇的临床特点及其妊娠结局。方法研究对象为2007年6月至2011年6月期间，四川大学华西第二医院收治的703例重度子痫前期病例，其中双胎妊娠131例，单胎妊娠572例。采用回顾性分析的方法，比较双胎组和单胎组孕妇的年龄、规律产检次数、发病孕周、分娩孕周、平均延长孕龄、血压值及实验室检测结果等临床指标，比较胎盘早剥、产后出血、子宫胎盘卒中、子痫、HELLP综合征（hemolysis，elevatedliverenzymes，andlowplateletssyndrome）等产科并发症，以及心功能衰竭、肺水肿、低蛋白血症、视网膜病变、颅内出血和肾功能不全等并发症发生情况。比较双胎组和单胎组围产儿的结局，包括早产率、围产儿死亡率、新生儿重症监护室（neonatalintensivecareunit，NICU）转入率，以及胎儿窘迫、新生儿缺血缺氧性脑病（hypoxic—ischemicencephalopathy，HIE）、新生儿窒息、肺炎、高胆红素血症和低血糖等疾病的发生率。采用t检验、χ2检验、校正四格表的χ2检验或Fisher精确概率法进行统计学分析。结果双胎组重度子痫前期发病率高于单胎组[5．03％（131／2604）与1．94％（572／29452），χ2=106．40，P〈0．001]。双胎组和单胎组的平均发病孕周分别为（33．6±1．8）周和（34．4±2．0）周，平均分娩孕周分别为（34．6±2．9）周和（35．6±3．2）周，平均延长孕龄分别为（6．4±0．3）d和（7．4±0．5）d，双胎组均早于单胎组（t=2．364、3．902和5．314，P均〈O．05）。双胎组与单胎组胎盘早剥[9．9％（13／131）与4．2％（24／572）]、心功能衰竭[11．5％（15／131）与3．2％（18／572）]、肺水肿[4．6％（6／131）与0．9％（5／572）]、产后出血[16．0％（21／131）与7．0％（40／572）]、子宫胎盘卒中[5．3％（7／131）与0．5％（3／572）]发生率比较，双胎组均高于单胎组（χ2=7．013、16．430、9．505、10．990和17．650，P均〈0．01）。双胎组与单胎组早产率E77．1％（202／262）与29．9％（171／572）]、新生儿HIE发生率r8．4％（22／262）与4．7％（27／572）]、新生儿NICU转入率E76．2％（205／262）与58．4％（332／572）]比较，双胎组均高于单胎组（χ2=162．000、4．392和31．980，P均〈O．05）。结论双胎妊娠较单胎妊娠更易发生重度子痫前期，且更易发生严重并发症，导致围产儿不良结局。临床应重视双胎妊娠的管理，一旦发生妊娠期高血压疾病应积极治疗并预防并发症，根据病情适时终止妊娠。

Objective To explore the clinical characteristics and pregnancy outcomes of twin pregnancies complicated with severe preeclampsia. Methods The pregnant outcomes of 131 twin pregnancies （twin group） and 572 singleton pregnancies （singleton group）, all complicated with severe preeclampsia, were analyzed retrospectively. All patients were treated in the Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University from June 2007 to June 2011. The patients~ age, onset of disease, gestational weeks at delivery, mean duration of expectant treatment, blood pressure, laboratory parameters and incidence of pregnancy complications, including placental abruption, heart failure, pulmonary edema, postpartum hemorrhage, uteroplacental apoplexy, eclampsia, HELLP syndrome （hemolysis, elevated liver enzymes and low platelets syndrome）, hypoproteinemia, retinopathy, intracranial hemorrhage and renal insufficiency, were compared between the two groups. Perinatal outcomes such as premature delivery, perinatal mortality, neonatal intensive care unit （NICU） hospitalization, fetal distress, hypoxic-ischemic encephalopathy （ HIE ）, asphyxia neonatorum, neonatal pneumonia, hyperbilirubinemia and neonatal hypoglycemia of two groups were also compared. Chi-square test, Fisher＇s exact test or t-test were used for statistical analysis. Results The severe preeclampsia incidence of twin pregnancies （5.03± 131/2604） was higher than that （1.94%, 572/29 452） of singleton pregnancy （χ2 =106.40, P〈0. 001）. The onset time [（33.6±1.8） weeks] and gestations at delivery [-（34.6±2.9） weeks] in twin group were earlier than those in singleton group E（34.4± 2.0） weeks, t=2.364, P〈0.05; （35.6±3.2） weeks, t=3.902, P〈0.05]. The duration of expectant treatment of twin group [-（6.4±0.3） d] were shorter than that of singleton group [-（7.4± 0.5） d, t=5.314, P〈0.01]. The incidence of placentalabruption [9.9% （13/131） vs 4.2% （24/ 572）, χ2=7.013, P%0.01], heart failure [11.5%0 （15/131） vs 3.2% （18/572）, χ2=16.430, P% 0.012, pulmonary edema ~4.6%0 （6/131） vs 0.9% （5/572）,χ2=9.505, P%0.011, postpartum hemorrhage [16.0% （21/131） vs 7.0% （40/572）,χ2== 10. 990, P%0.011 and uteroplacental apoplexy [5.3%0 （7/131） vs0.5~ （3/572）, χ2==17.650, P＇Q0.011 of twin group were higher than those of singleton group, respectively. The incidence of premature delivery [77.1% （202/262） vs 29.9%0 （171/572）, χ2=162.000, P〈0：051, NICU hospitalization [76.2% （205/262） vs 58.4% （332/572）,）χ2=31.980, P%0.051 and HIE [8.4%（22/262） vs 4.7% （27/572）, χ2=4.392, P% 0. 051 of twin group were higher than those of singleton group, respectively. Conclusions Twin pregnancy women are more likely to be complicated with severe preeclampsia and more vulnerable to suffer from severe complications, resulting in poor perinatal outcomes. More attentions should be paid on the management of twin pregnancy. Once hypertensive disorders complicating pregnancy is diagnosed, active management should be provided and timing of termination should be considered.