早发型和晚发型重度子痫前期特征及其围产结局的探讨

目的探讨分析早发型和晚发型重度子痫特征及其围产结局。方法回顾分析515例早发型和晚发型重度子痫前期患者的临床特征、器官受累比较、保守治疗可行性及意义、终止妊娠时机和分娩方式选择、围生儿结局。结果①早发型和晚发型两组间血压、发病孕周、终止孕周、治疗时间、系统产前检查例数比较，差异显著；②早发型患者尿酸、24h尿蛋白定量、红细胞压积均较晚发型患者增高，新生儿体质量低于晚发型新生儿体重，差异显著；③早发型和晚发型发生并发症各为135及237例次；发生器官受累各为91例及150例，均以单器官受累为主；④孕周越小转NICU病例越多，小于胎龄儿发生率和围产儿死亡率越高；⑤比较早发型两种分娩方式围生儿结局，显示除住NICU病例有明显差异，重度窒息、小于胎龄儿发生率和围生儿死亡率无显著差异。结论早发型重度子痫前期发病早、病情重，对母儿危害极大，严格选择病例、严密监护下，实施保守治疗，适时选择适当分娩方式终止妊娠可显著改善母儿的围生结局。

The Study about the Clinical Characteristics and Perinatal Outcomes of Early and Late Onset Severe Preeclampsia

Objective To analyze the clinical characteristics and perinatal outcomes of early and late onset zevere preeclampsia.Methods Retrospectively analyzed on the clinic data of 515 cases of severe preeclampsia patients.Studyed on the clinic characteristics and organ damage of early and late onset patients,analyzed the feasibility of expectant management and the choosing of terminating pregnancy time and delivery mode for severe preeclampsia patients and explored the perinatal outcomes of fetuses and newboms.Results①The blood pressure,onset gestation,terminating gestation,management time,prenatal examination of early onset group and late onset group were different statistically.②The level of uric acid,uric protein in 24 h and HCT of early onset patients were higher than late onset patients,and there was a staffstical difference The weight of newborns in early onset group was lower than that in late onset group,there was a statistical difference.③135 times of complications occurred in early onset group,while 237 times in late onset group,91 patients of early onset severe preeclampsia developed organ damage,while 150 patients of late onset severe preeclampsia developed organ damage.Most were single organ damage in both of the two type of severe preeclampsia.④Patients with fewer gestation weeks had higher rate of SGA and higher perinatal mortality rate,and more newborns were sent to NICU.⑤Both group of caesarean birth operation and group of vaginal delivery were no statistical differences in the rates of severe asphyxia,SGA and perinatal mortality between the two delivery mode,excepting the NICU cases.Conclusion Early onset severe eclampsia occurs early and does heavy harm to the maternity and child.We can improve the perinatal outcomes evidenfly by the way of choosing cases strictly,monitoring carefully,implementing expectant management and terminating pregnancy properly.