重度子痫前期病情发展与衍变396例分析

Analysis of the development and progress of severe preeclampsia

目的探讨重度子痫前期(sPE)患者病情的发展与衍变,寻求减少疾病发生、延缓病情发展及避免严重并发症和不良结局的临床要点。方法分析2009年1月至2012年12月于北京大学第三医院住院治疗并终止妊娠、在出院时诊断为重度子痫前期的396例患者资料,按入院情况进行分组,包括入院时为单纯sPE不伴有严重并发症(I-sPE)组330例;sPE伴有严重并发症(C-sPE)组33例;轻度子痫前期(mild preeclampsia)后发展为sPE(M-sPE)组23例;入院时无子痫前期诊断但住院后发展成为sPE(N-sPE)组10例。分析指标包括一般临床资料、产前检查情况及病情衍变分析。结果 (1)M-sPE组规律产检率最高(87%),C-sPE组规律产检率最低(50%)。重症首诊患者中,C-sPE组比例(63.6%)高于I-sPE组(44.2%)(P<0.05)。(2)C-sPE组首发征象出现最早,入院孕周较晚;M-sPE组诊断sPE孕周较晚,分娩孕周均值大于34孕周,无一例出现严重并发症。(3)N-sPE组10例均存在≥1个的预警信息;8例接受了常规性的规律产前检查;7例临床首发征象出现在入院前;入院至sPE诊断中位时间8.0(5.0,16.0)d;sPE诊断至分娩中位时间2.5(0.8,8.5)d。结论重度子痫前期可以经不同发病情形衍变而来,注重临床预警信息是早期识别重度子痫前期发病的重要环节之一,在存在子痫前期高危因素的孕妇尤其在期待治疗过程中应早期识别、注意防范重度子痫前期发生;产前检查和管理质量是影响重度子痫前期发病的重要因素。

Objective To analyze the development and progress of severe preeclampsia, and to search for the clinical key points to reduce the occurrence, delay progress and avoid serious complications. Methods Clinical observational data of 396 cases of severe preeclampsia （sPE） at discharge with termination of pregnancy in Peking University Third Hospital, a tertiary teaching hospital, from Jan.2009 to Dec.2012, were analyzed. Cases were divided into groups according to the clinical conditions at admission, including 330 cases of isolated severe PE cases without serious complications （I-sPE）, 33 cases with complications superimposed on severe preeclampsia （C-sPE）, 23 cases of mild PE （M-sPE）, and 10 cases with non-diagnosis of PE （N-sPE）. The general clinical data, prenatal care and development of pathogenic condition were analyzed. Clinical variables were analyzed by statistical methods. Results （1） The M-sPE group had the highest rate of regular prenatal care （87%）, and the C-sPE group had the lowest （50%）.C-sPE group had the higher ratio of patients without prenatal care （63.6% vs 44.2%）. （2）C-sPE group was the earliest of first symptom occurrence, and was late at gestational week of admission. M-sPE group was late at gestational week of diagnosis of sPE, and the median weeks of this group at termination was latter than 34 weeks. No serious complication occurred in this group. （3）All the patients of N-sPE group had one or more warning signs, 8 cases in regular prenatal care, and 7 cases had the first on- set symptom before admission. Time of admission to diagnosis was 8.0（5.0,16.0）days, and time of diagnosis to delivery was 2.5（0.8,8.5）days. Conclusions Different clinical conditions can evolve into severe preeclampsia. Emphasizing clinical warning information is one of important aspects in early recognizing the onset of preeclampsia. We should pay attention to early recognition and prevent the occurrence of severe preeclampsia in patients with high risk factors, especially during expectant management. Quality of prenatal care is an important factor involved in development of preeclampsia.