肝硬化代偿期和失代偿期孕妇临床特点、妊娠结局及处理措施分析

Analysis of clinical characteristics,pregnancy outcome and treatment measures of pregnant women with compensatory and compensatory stage of liver cirrhosis

目的探讨分析肝硬化代偿期和失代偿期孕妇的临床特点、妊娠结局及处理措施。方法选取2012年8月-2015年7月在内蒙古医科大学附属医院就诊的肝硬化合并妊娠妇女120例,根据患者肝功能将其分为代偿组(90例)和失代偿组(30例)。对比分析两组妇女的临床特点、妊娠结局及处理措施。结果失代偿组孕妇的乏力、上消化道出血、腹水、肝性脑病、肝肾综合征、脾功能亢进、凝血功能障碍的发生率明显高于代偿组孕妇,差异有统计学意义(χ~2=13.813、99.574、25.398、17.778、15.652、18.100、24.083,P<0.001)。两组孕妇妊娠结局死亡的发生率比较,差异无统计学意义(χ~2=3.025,P=0.082)。失代偿组孕妇的早产、产后出血、宫内窘迫、胎死宫内的发生率明显高于代偿组孕妇,差异有统计学意义(χ~2=5.182、9.641、17.778、17.600,P均<0.05)。失代偿组孕妇的天冬氨酸氨基转移酶(AST)、谷丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)水平明显高于代偿组孕妇,差异有统计学意义(t=-7.662、-8.916、-12.158,P<0.001)。失代偿组孕妇的白蛋白(ALB)水平明显低于代偿组孕妇,差异有统计学意义(t=6.222,P<0.001)。结论肝硬化失代偿期妊娠妇女妊娠不良结局发生率明显高于代偿期妊娠妇女,肝功能、凝血功能明显差于代偿期妊娠妇女。

Objective To analyze the clinical characteristics,pregnancy outcome and treatment measures of pregnant women with decompensatory and compensatory stage of liver cirrhosis.Methods 120 cases of patients with liver cirrhosis complicated with pregnancy received treatment in our hospital from August 2012 to July 2015 were slected.According to the liver function of the patients,all the women were assigned to compensatory group(90cases)and the decompensation group(30cases).Clinical characteristics,pregnancy outcome and treatment measures of the two groups were compared and analyzed.Results The incidence of fatigue,gastrointestinal bleeding,ascites,hepatic encephalopathy,hepatorenal syndrome,hypersplenism,coagulation dysfunction were shown to be significantly higher in the decompensated group than that in the compensated group(χ~2=13.813,99.574,25.398,17.778,15.652,18.100,24.083,P <0.001).No significant difference was observed in terms of incidence of death between the two groups(χ~2=3.025,P =0.082).The incidence of premature delivery,postpartum hemorrhage,fetal death and dead fetus in uterus was observed to be significantly higher in thedecompensation group than that of the compensation group(χ~2=5.182,9.641,17.778,17.600,0.002,P =0.023,<0.001,<0.001).The levels of AST,ALT and TBIL were presented to be remarkably higher in the decompensation group than those in compensatory group(t=-7.662,-8.916,-12.158,P <0.001).The ALB level was shown to be significantly lower in the decompensation group than that of the compensatory group(t=6.222,P <0.001).Conclusion The incidence rate of adverse pregnancy outcome in pregnant women with cirrhosis of the liver was observed to be significantly higher than that in the compensatorywomen,what's worse,the liver function and blood coagulation function were found to be significantly worse than those of the compensated pregnancy women.