未足月重度子痫前期孕妇血流变化及母儿结局研究

Relationship between blood flow changes and maternal-fetal outcomes in patients with preterm severe preeclampsia

目的探讨未足月重度子痫前期(SPE)患者胎儿脐动脉(UA)与大脑中动脉(MCA)的阻力指数(RI)的比值(RI_(UA/MCA))的变化及母儿结局的相关性。方法①选择2011年7月至2018年1月于南京医科大学附属苏州医院产科住院治疗并分娩的孕周<37周的108例重度子痫前期孕妇及其分娩的新生儿为研究对象。应用彩色多普勒超声血流频谱检测计算胎儿的RI_(UA/MCA),选取其中50例RI_(UA/MCA)≥1.0的孕妇纳入研究组,58例RI_(UA/MCA)<1.0的孕妇纳入对照组,比较两组孕妇的并发症、胎儿宫内情况及新生儿预后。②将108例未足月重度子痫前期孕妇以34周为界分为早发型组(n=38)和晚发型组(n=70),比较两组孕妇的并发症、胎儿宫内情况及新生儿预后。结果①研究组胎儿宫内窘迫发生率为38.0%,新生儿窒息发生率为22.0%;对照组分别为15.5%和8.6%,研究组均显著高于对照组,差异均有统计学意义(χ~2值分别为7.068、3.809,均P<0.05)。研究组孕妇的并发症(子痫、HELLP综合征、胎盘早剥、肾功能损害、心功能损害、视网膜脱落)发生率与对照组比较差异均无统计学意义(均P>0.05);研究组围生儿情况[胎儿生长受限(FGR)、新生儿颅内出血、新生儿败血症及新生儿死亡]的发生率与对照组比较差异均无统计学意义(均P>0.05)。②在重度子痫前期孕妇中,早发型组RI_(UA/MCA)≥1.0共28例(73.7%),RI_(UA/MCA)<1.0共10例(26.3%);晚发型组RI_(UA/MCA)≥1.0共22例(31.4%),RI_(UA/MCA)<1.0共48例(68.6%);早发型组中的RI_(UA/MCA)≥1.0的比例高于晚发型组。结论 RI_(UA/MCA)在一定程度上可反映未足月重度子痫前期围产儿的预后,可作为良好的预测指标。

Objective To investigate the relationship between fetal umbilical artery(UA)and middle cerebral artery(MCA)resistance index(RI)ratio(RIUA/MCA)and maternal-fetal outcomes in patients with preterm severe preeclampsia(SPE).Methods Altogether 108 pregnant women with severe preeclampsia and gestational week<37 undergoing childbirth and receiving treatment from July 2011 to January 2018 in obstetrics department of Suzhou Hospital Affiliated to Nanjing Medical University and their newborn babies were selected as study objects.Fetal RIUA/MCA was detected and calculated using color doppler ultrasound blood flow spectrometry.Fifty patients with RIUA/MCA≥1.0 were selected in study group,and 58 patients with RIUA/MCA<1.0 were included in control group.Complications,intrauterine situation of fetus and neonatal outcomes were compared in two groups.One hundred and eight pregnant women with severe preeclampsia before term were divided into early onset group(n=38)and late onset group(n=70)with 34 weeks as dividing line.Complications,intrauterine situation of fetus and neonatal outcomes were compared in two groups.Results Fetal distress rate and neonatal asphyxia rate in study group were 38.0%and 22.0%,respectively,and they were 15.5%and 8.6%,respectively in control group.They were significantly higher in study group than in control group(χ~2 value was 7.068 and 3.809,respectively,both P<0.05).Incidences of maternal complications(eclampsia,HELLP syndrome,placental abruption,renal dysfunction,cardiac dysfunction,retinal detachment)in study group were not significantly different from those in control group(all P>0.05).There were no significant differences in incidence of perinatal conditions[fetal growth restriction(FGR),neonate intracranial hemorrhage,neonatal septicemia and neonatal death]between study group and control group(all P>0.05).In severe preeclampsia patients,28 cases(73.7%)had RIUA/MCA≥1.0 and 10 cases(26.3%)had RIUA/MCA<1.0 in early onset group.Twenty-two cases(31.4%)had RIUA/MCA≥1.0 and 48 cases(68.6%)had RIUA/MCA<1.0 in late onset group.Proportion of cases with RIUA/MCA≥1.0 in early onset group was higher than that in late onset group.Conclusion RIUA/MCA can implicate perinatal outcomes of preterm severe preeclampsia and it is a good predictive index.