【作者】 陈明；

【导师】 于伟；

【作者基本信息】 吉林大学 ， 临床医学， 2012， 硕士

【摘要】 目的：研究早发型重度子痫前期的发病孕周与妊娠结局的关系;进一步探讨早发型重度子痫前期的患者终止妊娠的时机和方式。方法：回顾性分析我院产科收治的早发型重度子痫前期患者106例,根据其发病孕周分为4组,即A组(≤28周)、B组(孕28+1-30周)、C组(孕30+1-32周)、D组(孕32+1-34周)。分析不同孕周发病的孕妇，住院期间治疗时间、并发症情况、围产结局、随访产妇及新生儿预后的差异。结果:（1）早发型重度子痫前期发病孕周越早,患者并发症的发生率越高,但4组间总的并发症发生率比较P=0.285，无统计学意义。其中，孕妇合并低蛋白血症发生率最高，平均76.4%，其次为肝肾损害。（2）A、B、C各组孕妇婴儿存活率比较,差异无统计学意义(P>0.05),但与D组比较,差异有统计学意义(P <0.05)。（3）4组间的利凡诺引产率比较P=0.000,有显著差异。A组的利凡诺引产率与C跟D组有显著差异，P值分别为0.004,0.002。B组的利凡诺引产率与C跟D组有显著差异，P值分别为0.010,0.011。而A与B组之间没有差异。4组间的剖宫产率A<B<C<D,比较P=0.004，有显著差异。A组与C组的剖宫产率比较P=0.042，A组与D组的剖宫产率比较P=0.001，有显著差异。（4）出院后随访血压恢复到140/90mmHg以下的时间，发病孕周越晚，1个月内血压恢复正常的百分比越高，预后越好，4组间的比较有统计学意义。4组间3个月以上的尿蛋白转阴时间比较有统计学意义。结论：（1）从围生儿结局方面考虑，32-34孕周发病组的婴儿存活率达86.0%，与32孕周之前发病组比较有明显差异，新生儿预后得到了明显改善，产后血压恢复时间及尿蛋白转阴时间较32孕周之前发病组明显缩短，可考虑将EOSP的发病孕龄界定为32孕周。（2）治疗过程中应遵循个体化原则。28孕周前发病的EOSP在选择期待治疗时应慎重，短期内行期待治疗，若病情控制欠佳，宜及时终止妊娠，终止妊娠时选择剖宫产时应慎重，在孕妇病情允许的情况下尽量选择引产术经阴道分娩。对于28-32孕周发病患者治疗过程中一旦出现胎儿宫内窘迫或严重生长受限时或者孕妇病情不稳定、有严重并发症的病例，而距离32周尚早，应考虑以引产术终止妊娠；若病情平稳,尽可能维持妊娠至32孕周以后。对于32-34周发病的孕产妇无终止妊娠指征时则可以在三级医疗机构严密的监测下尽量延长孕周到34周，终止妊娠前首先评估母亲的基本状况，能否耐受产程过程、产道条件是否成熟，以及患者对胎儿是否积极救治的态度，在常规使用促胎肺成熟治疗后，选择性实行引产术；其余的患者则以剖宫产为主要终止妊娠方式。（3）发病孕周越早，血压恢复及尿蛋白转阴越慢，产妇预后越差。更多还原

【Abstract】 Objective: To explore the appropriate termination time and way ofwomen with early onset severe preeclampsia by investigating the relationsbetween the clinical characteristics and maternal and perinatal outcome;Method:106patients with early onset severe preeclampsia wereretrospectively reviewed in the second hospital of Jilin University．Patientswere divided into4groups: group A with onset before28weeks of gestation,group B with onset during28+1-30weeks of gestation, group C with onsetduring30+1-32weeks of gestation, and group D with onset during32+1-34weeksof gestation. Main outcome measures included prolongation of gestation,complications, perinatal outcomes, the prognosis of maternal and newbornbabies.Results:(1) The smaller the gestational weeks in early onset severepreeclampsia,the higher the maternal complication rates,but there was nosignificant difference among the gestational week groups，P=0.285. Amongthem, the pregnant women with hypoalbuminemia, the average rate was76.4%,followed by kidney and liver damage.(2) The difference of baby survival rateamong A, B and C was not statistically significant (P>0.05), but D groupcompared, the difference was statistically significant (P <0.05).(3) Betweenthe4groups who’s the induced labor rate quite P=0.000, a significantdifference. The induced labor rate of Group A compared with group C and Di ssignificant, P=0.004and0.002. Group B that’s the rate and C and D inducedlabor group there were significant differences, P=0.010and0.011. There is nodifference between group A and B. The cesarean section rate between the4groups was A<B<C<D, P=0.004, there was A significant difference. GroupA and C group of cesarean section rate was P=0.042, A group and group D cesarean section rate was more P=0.001, A significant difference.(4)follow-up of the time after discharge blood pressure returned to140/90mmHg,The bigger the gestational weeks in early onset severe preeclampsia,1monthsthe percentage of blood pressure returned to normal, the higher the betterprognosis, and the comparison between the group with a statistical significance.There was a statistical significance among the gestational week groups4groups over3months of urine protein turn into negative.Conclusion:(1) From the perinatal Outcome into consideration,32-34gestational age at the survival rate of up to86.0%of babies, and compared withbefore32weeks of pregnancy group have obvious difference, neonataloutcome improved, postpartum blood pressure recovery time and urine proteinnegativity before time is32of significantly reduced group, may consider theonset of EOSP gestational age defined gestational age at32.(2) The therapyprocess should follow the principle of individual. The onset of EOSP before28weeks of gestation should to be cautious when giving expectant treatment,short-term adept looking forward to treatment, if condition is poor control,appropriate termination of gestation in time, termination of pregnancy choiceshould be cautious when cesarean section, pregnant women in illness allow tryto choose the induced labor vaginal delivery operation. For28-30gestationalage at patients in the process of treatment fetus once appear within the distressor serious illness or limited growth when pregnant women not stable, cases ofserious complications, and far from32gestational age, should consider toterminate treatment; If condition is stable, as far as possible to maintainpregnancy to34weeks after pregnancy. For32weeks-34weeks of onset ofmaternal no termination of pregnancy is indications in level3medicalinstitutions closely monitored extend as far as possible with the thoughtful34weeks, neonatal outcome can be improved obviously, before the termination ofpregnancy first assess the situation of the mother can tolerate prolonged duration, the birth canal conditions could meet the requirements of prematureand shorten patients on whether the fetus positive attitude of the treatment, inroutine use of promoting child lung mature after treatment, the operationselective induced labor, the rest of the patients with cesarean section is as themain way termination of pregnancy.(3) The smaller the gestational weeks inearly onset severe preeclampsia, the slower blood pressure recovery and andurine protein negativity, the worse maternal prognosis.更多还原