子痫并发不同程度肝损害对母胎结局的影响

Investigate the maternal-fetal outcomes of eclampsia complicated with different degree of liver damage

目的:探讨子痫并发轻、中、重度肝功能损害的临床特点及对母胎结局的影响。方法:回顾分析2009年1月1日至2014年12月30日广州医科大学附属第三医院收治的79例子痫且合并肝功能损害患者的临床资料,按肝功能损害程度分为轻、中、重度3组,比较各组的临床特征及对母胎结局的影响。结果:子痫并发肝损害的发病率为0.24%(79/33084)。轻、中、重度肝功能损害患者的最高收缩压及舒张压比较,差异均有统计学意义(P<0.05);轻度与中、重度组的定期产检率比较,差异有统计学意义(P<0.05),但后两组比较差异无统计学意义(P>0.05);3组的抽搐次数比较,差异无统计学意义(P>0.05)。重度并发HELLP综合征与轻度与中度组比较,差异有统计学意义(P<0.05),后两组比较差异无统计学意义(P>0.05)。3组的入住ICU时间比较,差异有统计学意义(P<0.05),但并发胎盘早剥、心功能不全、产后出血率比较差异无统计学意义(P>0.05)。3组的新生儿窒息、胎儿生长受限、早产、转新生儿重症监护室率、围产儿死亡差异比较,差异均无统计学意义(P>0.05)。结论:血压控制不良加重肝脏损害;随着肝损害程度加重,HELLP综合征发生率及转重症监护室风险明显增加,但与围产儿结局无明显相关性。

Objective： To investigate the maternal-fetal outcomes of eclampsia complicated with different degree of liver damage and explore clinical disposal strategies. Methods： A retrospective chart review of all admissions between Jan. 1,2009 and Dec. 30,2014 included 79 cases with eclampsia who had been hospitalized with abnormal liver function divided into the light,moderate and severe liver damage in the Third Affiliated Hospital of Guangzhou Medical University. To compare the correlations between clinical features and maternal-fetal outcomes among three groups. Results： The incidence of eclampsia with hepatic dysfunction was 0. 24%（ 79 /33084）. There was statistically significant about systolic blood pressure /diastolic blood pressure among three groups（ P〈 0. 05）. There was statistically significant difference in the rate of regular prenatal between light and moderate,severe liver damage（ P〈 0. 05）. There was no statistically significant difference in the rate of regular prenatal between moderate liver damage and severe liver damage（ P〈 0. 05）. There was no statistically significant difference in the number of tic among three groups. There was no statistically significant difference in the rate ofHELLP syndrome between mild and moderate groups（ P 〉0. 05）,while it was statistically significant in the light and moderate,severe liver damage（ P 〉0. 05）. The difference of the ICU admission was statistically significant among three groups（ P〈 0. 05）. There were no statistically significant in the rate of placental abruption,heart dysfunction and postpartum hemorrhage among three groups. Also,there were no statistically significant difference in the rate of neonatal asphyxia,fetal growth restriction,preterm births,neonatal intensive care unit and perinatal death among three groups. Conclusion： Poor control of blood pressure aggravates liver damage. As the degree of liver damage is aggravating,the incidence of HELLP syndrome and turn to the intensive care unit are increasing,but it has no obvious correlation with perinatal outcomes.