【作者】 张楠；

【导师】 杨海澜；

【作者基本信息】 山西医科大学 ， 妇产科学（专业学位）， 2023， 硕士

【摘要】 目的:通过分析不同严重程度子痫前期患者的临床资料及母儿结局,探讨影响子痫前期发病程度及妊娠结局的高危因素。方法:对2007年1月1日至2021年12月31日于山西医科大学第一医院住院分娩的诊断为子痫前期的775例产妇的临床资料做一回顾性分析,分为无严重表现子痫前期组(MPE组,228例)和伴严重表现子痫前期组(SPE组,547例),对两组患者的一般资料、妊娠合并症及母儿结局进行分析。结果:(1)一般资料比较:SPE组分娩中位孕周为35周,MPE组为38周,SPE组剖宫产终止妊娠、不规律产检率高于MPE组,差异有统计学意义(P<0.05)。(2)妊娠合并症比较:SPE组合并糖尿病、胰岛素释放延迟、甲状腺功能减退症、亚临床甲状腺功能减退症、低钙血症占比高于MPE组,差异有统计学意义(P<0.05)。(3)母体不良妊娠结局比较:SPE组孕产妇胎盘早剥、心功能不全、低蛋白血症、HELLP综合征占比高于MPE组,差异有统计学意义(P<0.05)。(4)围产儿不良妊娠结局比较:SPE组新生儿窒息、死胎占比高于MPE组,差异有统计学意义(P<0.05)。(5)多因素分析:合并糖尿病、胰岛素释放延迟、甲状腺功能减退症、亚临床甲状腺功能减退症、低钙血症以及孕期不规律产检是影响子痫前期严重程度的独立风险因素(P均<0.05)。结论:(1)重度子痫前期患者由于病情严重,通常采取剖宫产方式终止妊娠,并且早产发生率高,因此在临床工作中,要权衡好分娩时机,以达到母儿最大获益。(2)合并有妊娠期糖尿病、胰岛素释放延迟、临床及亚临床甲状腺功能减退症、低钙血症者更容易发展为重度子痫前期,在产检时可对合并有这些疾病的孕妇给予更密切的关注及治疗,以最大可能地避免重度子痫前期的发生。(3)患有重度子痫前期孕妇不规律产检率高,社区以及产科医生应做好宣教及管理,以做好疾病的2级预防。更多还原

【Abstract】 Objective:By analyzing the clinical data of patients with different severity of preeclampsia and maternal and infant outcomes,to explore the high risk factors affecting the severity of preeclampsia and pregnancy outcome.Methods:a retrospective analysis on January 1,2007 to December 31,2021 in shanxi medical university first hospital childbirth of the clinical data of 775 cases of maternal,divided into no severe preeclampsia group(MPE group,228 cases)and associated with severe preeclampsia group(SPE group,547 cases),The general data,pregnancy complications and maternal and infant outcomes of the two groups were analyzed.Results:(1)Comparison of general data: the median gestational age of delivery was 35 weeks in the SPE group and 38 weeks in the MPE group.The rate of caesarean section termination and irregular birth detection in the SPE group was higher than that in the MPE group,and the difference was statistically significant(P < 0.05).(2)Comparison of pregnancy complications: The proportion of SPE group with diabetes,delayed insulin release,hypothyroidism,subclinical hypothyroidism and hypocalcemia was higher than that of MPE group,and the difference was statistically significant(P < 0.05).(3)Comparison of adverse maternal pregnancy outcomes: The comprehensive prevalence of placental abruption,cardiac insufficiency,hypoproteinemia and HELLP in SPE group was higher than that in MPE group,with statistical significance(P < 0.05).(4)Comparison of perinatal adverse pregnancy outcomes: the proportion of neonatal asphyxia and stillbirth in SPE group was higher than that in MPE group,the difference was statistically significant(P < 0.05).(5)Multivariate analysis: diabetes mellitus,delayed insulin release,hypothyroidism,subclinical hypothyroidism,hypocalcaemia and irregular prenatal examination were risk factors affecting the severity of preeclampsia(P < 0.05).Conclusion:(1)Due to the serious condition of severe preeclampsia,the pregnancy is usually terminated by cesarean section,and the incidence of premature birth is high.Therefore,in clinical work,the timing of delivery should be balanced to achieve the maximum benefit of mother and child.(2)Pregnant women with gestational diabetes mellitus,delayed insulin release,clinical and subclinical hypothyroidism,and hypocalcemia are more likely to develop into severe preeclampsia.More attention and treatment should be given to pregnant women with these diseases during the prenatal examination to avoid the occurrence of severe preeclampsia as much as possible.(3)The irregular birth rate of pregnant women with severe preeclampsia is high,so the community and obstetricians should do a good job in education and management,so as to do a good job in the second-level prevention of the disease.更多还原