82例重度子痫前期并发急性心力衰竭患者的临床分析

Clinical analysis of severe preeclampsia with acute heart failure:82 cases reports

目的探讨重度子痫前期患者并发急性心力衰竭的母婴结局。方法回顾性分析2009年1月至2013年1月在广州医科大学附属第三医院就诊的82例重度子痫前期并发急性心力衰竭患者的临床资料。结果 82例患者临床表现及查体均存在不同程度的异常,心肌酶谱和B型利钠肽前体升高。心功能Ⅲ级27例,Ⅳ级55例。82例患者平均总治疗时间(10.8±0.9)d,其中43例患者转入ICU治疗,入住ICU治疗时间(3.2±0.3)d,所有患者经积极治疗后,病情控制较好,无孕产妇死亡病例。活产新生儿83例,死胎5例,早产儿50例,新生儿窒息16例,41例转入新生儿重症监护病房治疗。活产新生儿平均体重(2 114.5±202.4)g,1 min、5 min、10 min Apgar评分平均为(6.4±0.6)分、(7.7±0.6)分和(8.3±0.5)分。结论重度子痫前期并发急性心力衰竭较易发生于34周之前和37周之后,且疾病发病孕周对产妇结局影响不大,但与新生儿结局密切相关。治疗原发疾病,控制血压,预防心衰的发生则是保证母婴结局的关键。

Objective To explore maternal and fetal outcomes of severe preeclampsia with acute heart failure .Methods Eighty-two cases of severe preeclampsia with acute heart failure in The Third Affiliated Hospital of Guangzhou Medical University from 2009 January to 2013 January were retrospectively analyzed.Results Eighty-two patients had abnormal clinical manifestation and physical examination .The lab indexes including myocardial enzymes and B-type natriuretic peptide precursor were increased .Among 82 patients, 27 patients developed cardiac function grading Ⅲ and 55 grading Ⅳ.The total average treatment time of 82 cases were 10.8 ±0.9 days, and 43 cases were admitted to ICU whose treatment time in ICU were 3.2 ±0.3 days.After timely treatment, all the patients had good outcomes without death case.There were 83 live births cases and 5 still births cases.Fifty cases of 83 live births were premature infants and 16 cases had neonatal asphyxia and 41 cases were admitted to the neonatal intensive care unit.The average weight of live newborns were 2 114.5 ±202.4 grams, and the average Apgar scores of 1 min, 5 min and 10 min were 6.4 ±0.6 scores, 7.7 ±0.6 scores and 8.3 ±0.5 scores, respectively .Conclusions The pregnancy women before 34 gestation weeks or after 37 gestation weeks were likely to developed severe preeclampsia with acute heart failure .The onset time strongly affect the outcome of newborns but not the mothers .Treating primary disease , blood pressure control and preventing heart function failure were the key points to ensure maternal and fetal outcomes .