妊娠期急性脂肪肝不同终止妊娠时机对妊娠结局的影响

Effect of Different Termination of Pregnancy in Acute Fatty Liver during Pregnancy on Pregnancy Outcome

目的分析妊娠期急性脂肪肝不同终止妊娠时机对妊娠结局的影响。方法本次58例研究对象均为我院2016年1月至2018年2月接收的妊娠期急性脂肪肝患者,按照不同终止妊娠时间将其平均分为两组,每组29例,研究组A在患者入院后采取保肝治疗,尽可能的延长患者孕周,如果肝肾功能减低则终止妊娠;研究组B则在确诊后立即终止妊娠,对两组妊娠解决以及终止妊娠后凝血功能、肝功能以及产后出血进行对比。结果研究组B产妇感染率以及新生儿轻度窒息率均较研究组A更低,差异有统计学意义(P<0.05);研究组A与研究组B产妇病死率、新生儿重度窒息率以及病死率未见显著差异,统计学无意义(P>0.05);研究组B术中出血量、术后出血量、APTT、PT、ALT、AST、TP、TBIL以及DBIL均显著优于研究组A,差异统计学意义成立(P<0.05)。结论及早诊断并在确诊为妊娠期急性脂肪肝48小时内立即终止妊娠,与此同时,给予患者血浆或者冷沉淀,有助于改善患者妊娠结局和预后效果。

Objective to analyze the effect of different timing of termination of pregnancy on pregnancy outcome in patients with acute fatty liver of pregnancy.Methods 58 cases of acute fatty liver disease of pregnancy received in our hospital in February-2018 January 2016 were divided into two groups according to the different termination time of pregnancy,29 cases in each group.The study group A took the liver preservation treatment after admission to the hospital,as far as possible to prolong the patient’s pregnancy,if the liver and kidney function decreased then the pregnancy terminated the pregnancy.The study group B immediately terminated pregnancy after the diagnosis,and compared the coagulation function,liver function and postpartum hemorrhage between the two groups.Results the rate of maternal infection and mild asphyxia of B in the study group were lower than that of the study group A,and the difference was statistically significant(P<0.05).There was no significant difference between the study group A and the study group B maternal mortality,the neonatal severe asphyxia rate and the mortality rate(P>0.05);the amount of bleeding during B in the study group and the postoperative outcome of the study group were not significant(P>0.05).Blood volume,APTT,PT,ALT,AST,TP,TBIL and DBIL were significantly better than those in study group A,and the difference was statistically significant(P<0.05).Conclusions Early diagnosis and immediate termination of pregnancy within 48 hours of the diagnosis of acute fatty liver disease in pregnancy,at the same time,plasma or cold precipitation can help to improve the outcome of pregnancy and prognosis.