早发型重度子痫前期患者的围产儿预后及影响因素分析

Analysis of perinatal prognosis and influencing factors in patients with early onset severe preeclampsia

目的探讨早发型重度子痫前期患者围产儿预后及影响因素。方法选取2005年4月至2008年4月盐城市妇幼保健院收治的妊娠28~33周分娩的早发型重度子痫前期患者90例,分析其围产儿预后及影响因素。结果 90例患者围产儿胎死宫内16例（17.8%）,引产中出现死产6例（6.7%）,新生儿出现重度窒息死亡10例（11.1%）,出生后因急性呼吸窘迫综合症（acute respiratory distress syndrome,ARDS）死亡2例（2.2%）,总死亡率为37.8%（34/90）。随访6年,13例失访,41例存活的新生儿发育过程中无明显异常,2例出现脑瘫。Logistic多元回归显示规律产检（OR=0.192）、分娩孕周（OR=2.217）、新生儿出生体质量（OR=1.003）、胎盘早剥（OR=6.512）、期待治疗天数（OR=6.512）,均是影响围产儿死亡的因素（P〈0.05）。结论早发型重度子痫前期对产妇和围产儿均有较大的伤害,应根据产妇及胎儿的具体情况选择适时终止妊娠,改善母儿预后。

Objective To explore the perinatal prognosis and influencing factors in patients with early onset severe preeclampsia. Methods 90 patients of 28 ~ 33 weeks of gestation with early onset of severe preeclampsia in Yancheng Material and Child Health Care Hospital from April 2005 to April 2008 were selected. The perinatal prognosis and influencing factors were analyzed.Results 16 cases（ 17. 8 %） were intrauterine fetal death,6 cases（ 6. 7 %） were death during treatment of labor induction,10 cases（ 11. 1 %） were severe neonatal asphyxia death,2 cases（ 2. 2 %） were ARDS death after birth,the total mortality was 37. 8%（ 34 /90）. After follow- up for 6 years,13 patients were withdraw,2 cases got cerebral palsy,41 survived newborns had no obvious abnormity. Logistic multiple regression showed that the regular prenatal examination（ OR = 0. 192）,gestational age（ OR = 6. 512）,neonatal weight（ OR = 1. 003）,placental abruption（ OR = 6. 512）,expectant treatment days（ OR = 2. 217） were the influencing factors of perinatal mortality（ all P 0. 05）. Conclusion The early onset severe preeclampsia has great harm to health of maternal and neonatal. It should terminate the pregnancy timely according to maternal and neonatal situation to improving the prognosis.