多胎妊娠合并妊娠期高血压疾病患者行剖宫产手术的分析

Analysis of Caesarean Section in Patients With Multiple Pregnancies Complicated With Hypertensive Disorders in Pregnancy

目的通过分析妊娠期高血压疾病行剖宫产手术患者临床资料,比较多胎妊娠与单胎妊娠间的临床特点及差异。方法回顾性分析2016年1月—2017年12月在福建省妇幼保健行剖宫产的妊娠期高血压疾病患者555例,根据是否多胎妊娠进行分组,比较其临床特点及母儿预后。结果两组患者年龄、产次、体质量指数(body mass index,BMI)、血小板计数(platelet count,PLT)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、尿素氮及血肌酐差异无统计学意义(P> 0.05)。在妊娠结局方面,两组硫酸镁用量、是否发生子痫及小于胎龄儿无显著差异。多胎妊娠合并妊娠期高血压疾病患者分娩孕周提前,差异有统计学意义(P <0.05)。妊娠期高血压疾病患者中多胎妊娠较单胎妊娠增加了低分子肝素使用率、早产率、产后出血率及输血率(P <0.05)。结论多胎妊娠合并妊娠期高血压疾病较单胎妊娠具有不同的临床特点和妊娠结局,围术期诊疗重点有所差异,个体化诊疗有利于提升医疗质量,改善母儿预后。

Objective To compare the clinical characteristics and differences between multiple pregnancy and singleton pregnancy by analyzing the clinical data of patients with hypertensive disorders in pregnancy undergoing cesarean section. Methods A total of 555 patients with hypertensive disorders in pregnancy who underwent cesarean section in Fujian Province from January 2016 to December 2017 were analyzed retrospectively. The patients were divided into two groups according to multiple pregnancies, and their clinical characteristics and maternal and fetal prognosis were compared. Results There was no significant difference in age, parity, body mass index(BMI), platelet count(PLT), alanine aminotransferase(ALT), urea nitrogen and serum creatinine between the two groups(P > 0.05). In terms of pregnancy outcome, there was no significant difference in the dosage of magnesium sulfate, eclampsia and small gestational age infants between the two groups. The gestational weeks of multiple pregnancies with hypertensive disorders in pregnancy were earlier, and the difference was statistically significant(P < 0.05). In patients with hypertensive disorders in pregnancy, the utilization rate of low molecular weight heparin, premature delivery, postpartum hemorrhage and blood transfusion rate in multiple pregnancy were higher than those in singleton pregnancy(P < 0.05). Conclusion Multiple pregnancy complicated with hypertensive disorders in pregnancy has different clinical characteristics and pregnancy outcome than singleton pregnancy,and the key points of perioperative diagnosis and treatment are different.Individualized diagnosis and treatment are beneficial to improve medical quality and improve maternal and fetal prognosis.