妊娠期高血压并发多器官功能障碍综合征的流行病学特点及血浆置换联合血液净化对其病死率的影响调查

Epidemiological Characteristics of Hypertensive Disorder Complicating Pregnancy Complicated with Multiple Organ Dysfunction Syndrome and Effect of Plasma Exchange Combined with Blood Purification on Its Fatality Rate

目的调查妊娠期高血压疾病并发多器官功能障碍综合征的流行病学特点,探讨血浆置管联合血液净化对其病死率的影响。方法收集我院2012年6月—2016年6月400例妊娠期高血压疾病患者病历资料,其中52例患者并发多器官功能障碍综合征,收集所有患者临床资料。将妊娠期高血压疾病并发多器官功能障碍综合征患者按随机数表法分为观察组与对照组,每组26例。对照组在常规治疗基础上给予血液净化治疗,观察组在常规治疗基础上给予血浆置换联合血液净化治疗,均持续3 d。检测患者治疗前与治疗3 d后免疫功能、循环功能、呼吸功能及肾功能,统计病死率。结果妊娠期高血压疾病并发多器官功能障碍综合征患者重度子痫前期、瘢痕子宫、初中及以下文化程度患者比例显著高于单纯妊娠期高血压疾病(P<0.05)。经Logistic回归分析,疾病类型、瘢痕子宫、文化程度是妊娠期高血压疾病患者并发症多器官功能障碍综合征的独立影响因素。观察组治疗3 d后辅助性T细胞1(Th1)、Th1/Th2显著高于对照组(P<0.05),Th2、心率、收缩压、舒张压、尿素氮、血肌酐显著低于对照组(P<0.05),病死率显著低于对照组(P<0.05)。结论疾病类型、瘢痕子宫、文化程度等3个因素对妊娠期高血压疾病患者并发多器官功能障碍综合征有显著影响。血浆置换联合血液净化可以纠正患者免疫失衡,改善循环功能,稳定内环境,降低死亡风险。

Objective To investigate the epidemiological characteristics of hypertensive disorder complicating pregnancy（ HDCP） complicated with multiple organ dysfunction syndrome（ MODS） and the effect of plasma exchange combined with blood purification on fatality rate. Methods The medical records of 400 patients with HDCP who were admitted to our hospital from June 2012 to June 2016 were collected. It was found that there were 52 patients with MODS among the 400 patients,and clinical data of the 52 patients were collected. The patients with HDCP complicated with MODS were divided into the observation group and the control group by the random digit table method,26 cases in each group. Apart from conventional treatment,the control group was treated with blood purification and the observation group was treated with plasma exchange combined with blood purification,both lasting for 3 days. The immune function,circulatory function,respiratory function and renal function of the patients were detected before and after three-day treatment and the morbidity and mortality were statistically analyzed. Results The proportion of HDCP complicated with MODS patients with severe preeclampsia,scarred uterus and education level of secondary schooling or even lower was significantly higher than that in patients with simple HDCP（ P〈0. 05）. Logistic regression analysis showed that the type of the disease,scarred uterus and educational level were independent factors influencing patients with hypertensive disorder complicating pregnancy complicated with multiple organ dysfunction syndrome. The helper T cell 1（ Th1） and Th1/Th2 in the observation group were significantly higher than those in the control group after 3 days of treatment（ P〈0. 05）,while the Th2,heart rate,systolic blood pressure,diastolic blood pressure,usea nitrogen,serum creatinine and the case fatality rate were significantly lower than those in the control group（ P〈0. 05）. Conclusion The type of the disease,scarred uterus and educational level greatly influence patients with hypertensive disorder complicating pregnancy complicated with multiple organ dysfunction syndrome. Plasma exchange combined with blood purification can correct immune imbalance,improve the circulatory function,stabilize the internal environment and reduce the risk of death in patients.