子痫前期合并阻塞性睡眠呼吸暂停低通气综合征的临床分析

Clinical analysis of preeclampsia with obstructive sleep apnea hypopnea syndrome

目的探讨子痫前期合并阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的临床特征及其母婴近期结局。方法选择2018年6月至2019年6月在东莞市人民医院收治住院的子痫前期孕妇,共有68例孕妇纳入研究,经多导睡眠监测确诊为OSAHS设为OSAHS组32例,未符合诊断标准者为非OSAHS组36例,并收集两组的临床资料进行分析。结果两组孕妇年龄、重度子痫发生率、发病孕周差异均无统计学意义(P>0.05)。OSAHS组孕妇未规律产检者多见(P<0.05)。OSAHS组ESS评分(9.25±3.51)分,睡眠呼吸暂停低通气指数(10.56±3.40)次/h,高于非OSAHS组[(6.89±3.11)分、(3.17±0.94)次/h](P<0.01);夜间最低血氧饱和度(85.22±3.40)%,较非OSAHS组低(93.10±2.09)%(t=-11.661,P<0.01)。OSAHS组孕前体重指数(23.76±3.38)kg/m^(2)、孕早期体重增加(1.62±1.03)kg、颈围(36.72±3.07)cm,分别较非OSAHS组高[(22.02±0.57)kg/m^(2)、(0.87±0.93)kg和(35.17±2.27)cm](P<0.01)。OSAHS组孕妇早产发生率(78.13%,25/32),高于非OSAHS组(55.56%,19/36)(X^(2)=4.766,P<0.05)。OSAHS组的新生儿窒息率为(28.13%,9/32),高于非OSAHS组(8.33%,3/36)(X^(2)=4.566,P<0.05);OSAHS组的新生儿Apgar评分较低且新生儿重症监护病房入住率较高;两组新生儿出生体重、气管插管率差异均无统计学意义(P>0.05)。结论对存在打鼾现象的孕妇应给予更多的关注,孕前体重指数水平过高、孕早期增重过量、颈围过长是子痫前期孕妇发生OSAHS的危险因素,及时诊断是否为OSAHS并进行必要早期干预有效促进母婴健康。

Objective To explore the clinical characteristics of preeclampsia with obstructive sleep apnea hypopnea syndrome(OSAHS)and the short-term outcomes of mother and newborn.Methods 68 pregnant women with preeclampsia,who were admitted to Dongguan people′s hospital from June 2018 to June 2019,were selected.The patients were divided into two groups.32 patients in OSAHS group,were diagnosed as OSAHS by polysomnography(PSG).36 patients did not meet the diagnostic criteria,who were set as Non-OSAHS group.Clinical data of two groups were collected for analysis.Results There were no significant difference in age,incidence of severe eclampsia and gestational age between two groups(P>0.05).The number of pregnant women with irregular prenatal examination in OSAHS group was higher than in Non-OSAHS group(P<0.05).The ESS score(9.25±3.51)and AHI[(10.56±3.40)/h]were higher in OSAHS group than that in Non-OSAHS group(P<0.01).The lowest nighttime SpO 2[(85.22±3.40)%]was lower in OSAHS group than that in Non-OSAHS group(P<0.01).The pre-pregnancy BMI[(23.76±3.38)kg/m^(2)],weight gain in early pregnancy[(1.62±1.03)kg]and neck circumference[(36.72±3.07)cm]in the OSAHS group were higher than those[(22.02±2.57)kg/m^(2)、(0.87±0.93)kg、(35.17±2.27)cm]in the non-OSAHS group(P<0.01).The incidence of preterm delivery in OSAHS group was higher than in Non-OSAHS group(P<0.05).Neonatal asphyxia rate,Apgar score and the rate of newborn transferring to NICU in OSAHS group were significantly higher than in Non-OSAHS group(P<0.05).However,there were no significant difference in birth weight and tracheal intubation rate in two groups.Conclusions Pregnant women with snore should be paid more attention.High pre-pregnancy BMI,excessive weight gain in early pregnancy and excessive neck circumference are the risk factors for preeclampsia patients to have OSAHS.Timely diagnosis and effectively intervention of OSAHS may promote maternal and infant health.