妊娠期高血压疾病严重并发症的发生规律及其对母儿的影响

目的探讨妊娠期高血压疾病严重并发症的发生规律及其对孕产妇和围产儿的影响。方法对1995-2004年南方医科大学南方医院、珠江医院、广州市第二人民医院和广州市番禺区何贤纪念医院共71020例孕妇中的4107例妊娠期高血压疾病患者的临床资料进行回顾性分析。结果（1）妊娠期高血压疾病发生率：为5．78％（4107／71020），其中重度子痫前期为27．78％（1141／4107），轻度子痫前期为72．22％（2966／4107）。（2）妊娠期高血压疾病严重并发症发生率：胎盘早剥为1．68％（69／4107），DIC为1．36％（56／4107），妊娠期高血压疾病性心脏病为1．05％（43／4107），肾功能衰竭为0．97％（40／4107），脑血管意外为0．58％（24／4107），溶血、肝酶升高、低血小板计数（HELLP）综合征为0．51％（21／4107）。（3）孕产妇死亡：孕产妇均死于多重并发症，死亡率为0．19％（8／4107），死亡专率为11．26／10万（8／71020），死亡病例中，脑血管意外4例次（17％，4／24），HELLP综合征2例次（10％，2／21），DIC3例次（5％，3／56），妊娠期高血压疾病性心脏病1例（2％，1／43）。（4）围产儿死亡：围产儿死亡率为3．01％（130／4319）。死亡病例中，孕产妇发生胎盘早剥33例（43％，33／77），HELLP综合征10例（42％，10／24），DIC22例（34％，22／64），肾功能衰竭11例（25％，11／44），脑血管意外6例（24％，6／25），妊娠期高血压疾病性心脏病8例（16％，8／49）。结论（1）妊娠期高血压疾病严重并发症的发生率由高到低依次为：胎盘早剥、DIC、妊娠期高血压疾病性心脏病、肾功能衰竭、脑血管意外、HELLP综合征。（2）致孕产妇死亡的并发症依次为：脑血管意外、HELLP综合征、DIC和妊娠期高血压疾病性心脏病。（3）致围产儿死亡的孕妇并发症依次为：胎盘早剥、HELLP综合征、DIC、肾功能衰竭、脑血管意外和妊娠期高血压疾病性心脏病。

Morbidity regularity of severe complications of hypertensive disorder complicating pregnancy in clinics

OBJECTIVE: To analyse incidence of the severe complications of hypertensive disorder complicating pregnancy and the influence on the outcome of pregnancy. METHODS: A retrospective study of 4107 cases among 71 020 cases who delivered in hospitals from 1995 to 2004 in Guangzhou was conducted. RESULTS: The morbidity of hypertensive disorder complicating pregnancy was 5.78%, in which the morbidity of severe pre-eclampsia was 27.78% (1141/4107), of mitis pre-eclampsia was 72.22% (2966/4107). Maternal mortality rate was 0.19% (8/4107), and the specific mortality rate was 11.26/100 000. The proportion of severe complications of hypertensive disorder complicating pregnancy from high to low was as follows: placental abruption 1.68% (69/4107), DIC 1.36% (56/4107), hypertensive disorder complicating pregnancy induced cardiopathy (induced cardiopathy) 1.05% (43/4107), renal failure 0.97% (40/4107), cerebrovascular accident 0.58% (24/4107), and hemolysis, elevated liver enzymes and low platelet (HELLP) syndrome 0.51% (21/4107). Mortality caused by severe complications of hypertensive disorder complicating pregnancy were as follows: cerebrovascular accident 17% (4/24), HELLP syndrome 10% (2/21), DIC 5% (3/56) and induced cardiopathy 2% (1/43). The proportion of perinatal mortality from severe complications were as follows: placental abruption 43% (33/77), HELLP syndrome 42% (10/24), DIC 34% (22/64), renal failure 25% (11/44), cerebro vascular accident 24% (6/25) and induced cardiopathy 16% (8/49). CONCLUSIONS: (1) The morbidity of severe complications from high to low are: placental abruption, DIC, induced cardiopathy, renal failure, cerebro vascular accident and HELLP syndrome. (2) The main causes of mortality for gravida and puerperant are: cerebro vascular accident, HELLP syndrome, DIC and induced cardiopathy. (3) The major complications harmful to perinatal newborns are in the order of: placental abruption, HELLP syndrome, DIC, renal failure, cerebro vascular accident and induced cardiopathy.