重度子痫前期病情发展与衍变分析

Analysis of progression and evolvement in severe preeclampsia

目的：探讨重度子痫前期（sPE）患者疾病的衍变与发展，寻找避免不良结局与严重并发症、延缓疾病发展、减少疾病发生的方法。方法选取产科住院并妊娠终止，出院时诊断为 sPE 的患者280例。根据是否发生并发症及病情衍变对患者进行分组，即不伴有严重并发症组（I-sPE 组，n ＝233），伴有严重并发症组（C-sPE 组， n ＝23），由轻度子痫前期发展为 sPE 组（M-sPE 组，n ＝16），入院时无疾病入院后发展为 sPE 组（N-sPE 组，n ＝8）。对患者的病情衍变、产前检查及一般临床资料进行分析。结果 C-sPE 组规律产检率最低（5.1％），M-sPE 组的规律产检率最高（50.0％）；重症首诊患者中，C-sPE 组的患者比例显著高于 I-sPE 组（77.5％比42.5％，P ＜0.05）。首发征象到诊断时间 N-sPE 组最短，M-sPE 组最长；C-sPE 组入院孕周最晚，出现首发征象最早；首发征象到诊断时间 N-sPE 组最短，M-sPE 组最长。入院至分娩时间 C-sPE 组最短，N-sPE 组最长；诊断至分娩时间 C-sPE 组最短， N-sPE组最长。23例（100.0％）C-sPE 患者在入院时伴有严重并发症，M-sPE 组无患者发生严重并发症。所有8例N-sPE 患者都存在至少一个预警信息；6例患者进行了规律产检，5例患者在入院前出现临床首发征象。入院到sPE 诊断时间为8.1（5.2～16.3）d，sPE 诊断到分娩的时间为2.6（0.9～8.6）d。结论重度子痫前期疾病可由不同发病状况衍变而来，早期识别重度子痫前期发病的重要方法是注重临床预警信息；对于具有子痫前期高风险因素的孕妇，在其期待治疗过程中应尽早进行识别，防范重度疾病发生；而产前检查的质量是影响重度子痫前期发病的重要因素。

Objective To analyze the progression and evolvement in severe preechampsia （sPE）. Search method to avoid adverse outcomes and severe complications,delay disease progression, reduce disease. Methods Two hundred and eighty patients who were terminated pregnancy and diag-nosed PE at discharge. The patients were grouped as isolated severe PE cases without serious complica-tions group（I-sPE group,n = 233）,complications superimposed on severe preeclampsia group（C-sPE group,n = 23）,mild PE group（M-sPE group,n =16）and with non-diagnosis of PE group（N-sPE group, n =8）. To analyze evolution of the disease,prenatal care and clinical data in patients. Results C-sPE group had a lowest Check-rate law（ 5. 1% ）,regular check-rate of M-sPE group was the highest （50. 0% ）. The proportion of severe C-sPE first diagnosed patient group was significantly higher than the I-sPE group（77. 5% vs 42. 5% ,P 〈 0. 05）. The time of N-sPE group from starting signs to diagnose was the shortest time,and the time of M-sPE was longest time. The admission gestational age of C-sPE group was the latest,The time of the emergence of starting signs was the earliest. The N-sPE group time of first signs to diagnose was the shortest time. And the time of M-sPE was the longest time. The C-sPE group time of admission to delivery time was the shortest time. And the time of N-sPE was the longest time. The C-sPE group time of diagnosis to delivery time was the shortest time. And the time of N-sPE was the shor-test time. Twenty-three（100. 0% ）C-sPE patients on admission with severe complications,M-sPE group of patients without serious complications. All of the 8 cases of N-sPE had at least a warning information;6 patients were laws of birth,first clinical signs 5 patients before admission. Admission to sPE diagnosis time was 8. 1（5. 2-16. 3）days,sPE diagnosis to delivery was 2. 6（0. 9-8. 6）days. Conclusions Severe preeclampsia disease may be evolved from different incidence. Early recognition of severe pre-eclampsia is important is to focus on clinical warning information. Different from the situation evolve,for pregnant women with a high risk factor for pre-eclampsia,in its expected course of treatment as soon as possible identification,prevention of severe disease,and the quality of prenatal care is an important factor of se-vere preeclampsia.