妊娠合并有症状肾积水的临床疗效分析

Clinical efficacy of pregnancy complicated with symptomatic hydronephrosis

目的探讨妊娠合并有症状肾积水的临床特点。方法收集2019年1月1日至2020年1月1日在本院定期产检且有完整产检及分娩记录且合并肾积水的4379例孕妇的临床资料,按照有无症状分为有症状组(271例)和无症状组(4108例)。有症状的患者按治疗方式分为保守治疗组(140例)和手术治疗组(131例)。分析孕妇的肾积水发生率、有症状肾积水占比。结果有症状组的年龄小于无症状组,差异有统计学意义(P<0.05)。有症状组的初产妇、发病前2周内有性生活者、菌尿、尿蛋白阳性占比及空腹血糖值均高于无症状组,差异均有统计学意义(均P<0.05)。有症状组和无症状组的多胎妊娠、孕期、肾积水分级、体重指数、收缩压、肾积水部位、血红蛋白、总胆固醇、肌酐比较,差异无统计学意义(均P>0.05)。手术治疗组的孕周、视觉模拟评分(VAS)、心率、白细胞(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、尿培养阳性率及住院时间高于保守治疗组,差异均有统计学意义(均P<0.05)。保守治疗组和手术治疗组的年龄、体温、恶心、收缩压、舒张压及肾积水情况比较,差异均无统计学意义(均P>0.05)。结论妊娠合并肾积水的发病率高,有症状患者大多可行保守的治疗,症状较重或保守疗效不满意者需要手术治疗,双J管植入术安全、疗效满意。

Objective To investigate the clinical efficacy of pregnancy complicated with symptomatic hydronephrosis.Methods From January 1,2019 to January 1,2020,data of 4379 pregnant women with complete labor and delivery records and complicated hydronephrosis were collected and divided into symptomatic group(271 cases)and asymptomatic group(4108 cases)according to the presence or absence of symptoms.Patients with symptoms were divided into conservative treatment group(140 cases)and surgical treatment group(131 cases).The incidence of hydronephrosis and the proportion of symptomatic hydronephrosis in pregnant women were analyzed.Results The symptomatic group was younger than the asymptomatic group,and the difference was statistically significant(P<0.05).The number of primiparas,sex within 2 weeks before onset,bacteriuria,positive urinary protein and fasting blood glucose in the symptomatic group were higher than those in the asymptomatic group,and the diferences were statistically significant(all P<0.05).There were no significant differences in multiple pregnancy,pregnancy,hydronephrosis grade,body mass index,systolic blood pressure,hydronephrosis site,hemoglobin,total cholesterol and creatinine between the symptomatic group and asymptomatic group(all P>0.05).The gestational age,VSA pain score,heart rate,WBC,CRP,PCT,positive rate of urine culture and length of hospital stay in the surgical treatment group were higher than those in the conservative treatment group,and the differences were statistically significant(all P<0.05).There were no significant differences in age,body temperature,nausea,systolic blood pressure,diastolic blood pressure and hydronephrosis(all P>0.05).Conclusions The incidence of pregnancy complicated with hydronephrosis is high.Most symptomatic patients can be treated conservatively,and those with severe symptoms or unsatisfactory conservative effect need surgical treatment,double-J implantation is safe and effective.