【摘要】 目的探讨重度子痫前期终止妊娠时机。方法回顾性分析我院2000年1月~2006年3月收治的141例重度子痫前期患者(发病孕周为28~35+6周)的临床资料,按发病孕周将其分成四组28~29+6周、30~31+6周、32~33+6周和34~35+6周,分析实施期待治疗与积极治疗的产科和围产结局。结果①四组的期待治疗平均延长孕龄分别为(5.5±1.8)d、(12.7±6.6)d、(9.7±5.2)d和(7.5±4.1)d,四组间比较,差异有统计学意义(P<0.05);②发病孕周在28~33+6周组的期待治疗者的新生儿窒息率和NICU住院率均低于积极治疗组(P<0.05),期待治疗组的新生儿体重明显大于积极治疗组(P<0.01);而34~35+6周期待治疗组的新生儿窒息率、NICU住院率和新生儿体重与积极治疗组比较差异均无统计学意义(P>0.05);③多因素Logistic回归分析显示在28~33+6周期待治疗可以降低新生儿窒息率且没有加重孕妇脏器损害,而在34~35+6周组期待治疗并未改善母儿结局;④本研究无孕产妇死亡及后遗症发生。结论根据发病孕周不同,对重度子痫前期患者进行恰当的期待治疗,尽可能延长孕周至34周以后终止,有利于改善围生儿结局。更多还原

【Abstract】 Objective To explore the effect of timing of pregnancy termination on maternal and fetal outcomes in severe pre-eclampsia. Methods One hundred and forty-one women with severe pre-eclampsia at 28~35 +6 gestation week admitted to our hospital from Jan. 2000 to Mar. 2006 were retrospectively investigated. They were divided into four groups according to the onset time of the disease: 28～29 +6 week, 30～31 +6 week, 32～33 +6 week and 34～35 +6 week. The maternal and fetal outcomes were compared between the expectant management and aggressive management. Results ① The average pregnancy prolongation in four groups were (5.5±1.8), (12.7±6.6), (9.7±5.2) and (7.5±4.1) days, respectively. Significant difference was observed among them (P<0.05). ② In group 28～33 +6 week, the rate of neonatal asphyxia and hospitalization in neonatal intensive care unit (NICU) with expectant management were lower than those with aggressive management (P<0.05) and the birth weight in the expectant management was significantly higher than that in aggressive management (P<0.01). ③ The logistic regression showed that expectant management could improve the maternal and perinatal outcomes in group 28～33 +6 week. ④ No death and sequela in gravida was found in this study. Conclusions Appropriate expectant management of severe pre-eclampsia should be considered according to gestation week of disease onset following sufficient and careful assessment of the mother and fetus. Terminating pregnancy after 34th gestation week benefits the neonatal outcomes.更多还原