不同类型妊娠期高血压疾病母婴结局临床分析

Clinical analysis of maternal and neonatal outcomes of different types of hypertensive disorder complicating pregnancy

目的 探讨不同类型妊娠期高血压疾病的母婴结局。方法选取全国14个省(自治区、直辖市)39家医院(其中三级医院20家,二级医院19家)2016年1月1日至2016年12月31日所有诊断为妊娠期高血压疾病并住院分娩的6007例产妇的临床资料,其中妊娠期高血压2003例(Ⅰ组),轻度子痫前期917例(Ⅱ组),重度子痫前期2516例(Ⅲ组),子痫68例(Ⅳ组),慢性高血压并发子痫前期232例(Ⅴ组),慢性高血压271例(Ⅵ组)。分析不同类型妊娠期高血压疾病的母婴结局。结果①孕产妇结局:并发症发生率分别为肾功能不全0.3%(18例),心衰或肺水肿0.6%(34例),HELLP综合征1.6%(94例),胎盘早剥2.7%(162例),产后出血6.5%(388例),早产25.0%(1504例),孕产妇死亡0.1%(6例)。各组间胎盘早剥及产后出血发生率差异有显著性(P<0.05)。Ⅳ组的胎盘早剥发生率最高,达8.8%(6例)。Ⅱ组的产后出血发生率最高,达7.7%(71例)。②围产儿结局:共有围产儿6450例。小于孕龄儿(small for gestation age,SGA)的发生率为5.9%(382例),胎儿窘迫的发生率为9.6%(622例),新生儿窒息的发生率为9.5%(610例),新生儿合并症发生率为5.4%(350例),围产儿死亡率为4.6%(295例)。6组新生儿体重及SGA、新生儿窒息、新生儿合并症、围产儿死亡发生率经比较差异均有显著性(P<0.05)。Ⅲ组(2801例)的SGA发生率最高,达9.7%(272例),而Ⅳ组(70例)的胎儿窘迫及新生儿窒息发生率最高,分别为17.1%(12例)及35.7%(25例),V组(236例)的围产儿死亡发生率最高,达11.0%(26例)。结论不同类型的妊娠期高血压疾病母婴结局不同,重度子痫前期、子痫和慢性高血压并发子痫前期对孕产妇及围产儿危害更为严重,更应积极治疗和预防。

Objective To explore the maternal and neonatal outcomes of different types of hypertensive disorder complicating pregnancy.Method A total of 6007 cases of patients diagnosed as hypertensive disorder complicating pregnancy were selected from thirty-nine hospitals（including 20 tertiary hospitals and 19 secondary hospitals） from 14 provinces in China from January 1, 2016 to December 31, 2016. There were 2003 cases of gestational hypertension（group Ⅰ）, 917 cases of mild preeclampsia（group Ⅱ）, 2516 cases of severe preeclampsia（group Ⅲ）, 68 cases of eclampsia（group Ⅳ）, 232 cases of chronic hypertension complicated with preeclampsia（group V）, 271 cases of chronic hypertension complicating pregnancy（groupⅥ）. We analyzed the maternal and neonatal outcomes of different types of hypertensive disorder complicating pregnancy. Result ①Maternal outcomes： the complications of hypertensive disorder during pregnancy included renal insufficiency（0.3%）, heart failure/pulmonary edema（0.6%）, HELLP syndrome（1.6%）, placental abruption（2.7%）, postpartum hemorrhage（6.5%）, preterm labor（25.0%）, maternal mortality（0.1%）. The incidence of placental abruption and postpartum hemorrhage in each group was significantly different（P〈0.05）. The incidence of placental abruption was the highest in group Ⅳ（8.8%）. The incidence of postpartum hemorrhage in group Ⅱ was the highest（7.7%）. ②Neonatal outcomes： the incidence of small for gestation age（SGA） in hypertensive disorder complicating pregnancy was 5.9%, the incidence of fetal distress was 9.6%, the incidence of neonatal asphyxia was 9.4%, the incidence of neonatal comorbidity was 5.4%, the neonatal mortality rate was 4.6%. The neonatal weight, SGA incidence, neonatal asphyxia, neonatal comorbidity and neonatal death were significantly different（P〈0.05） of the six groups. The incidence of SGA was the highest in severe preeclampsia（9.7%）. The incidence of fetal distress and neonatal asphyxia was17.1% and 35.7% in eclampsia group, while the neonatal mortality rate was the highest（11.0%）in the chronic hypertension complicated with preeclampsia group. Conclusion The maternal and neonatal outcomes of different types of hypertensive disorder complicating pregnancy are different. Severe preeclampsia, eclampsia and chronic hypertension complicated with preeclampsia are more serious to pregnant women and perinatal fetus, and should be actively treated and prevented.