重度先兆子痫孕妇发病孕龄与母婴预后的关系

目的：分析重度先兆子痫孕妇不同发病孕龄对母婴预后的影响。方法选择2007年1月至2013年10月于广西医科大学第一附属医院住院治疗的468例重度先兆子痫孕妇为研究对象,并按照发病孕龄将其分为 A组（n=75,孕龄＜28孕周,平均为26.01孕周）,B组（n=99,孕龄为28~31＋6孕周,平均为30.62孕周）,C组（n=84,孕龄为32~33＋6孕周,平均为33.05孕周）,D 组（n=210,孕龄≥34孕周,平均为37.70孕周）。本研究遵循的程序符合广西医科大学第一附属医院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书。比较4组孕妇的临床特点、并发症发生情况和围生儿结局。结果4组不同发病孕龄的重度先兆子痫孕妇发病时年龄、收缩压、舒张压比较,差异均无统计学意义（F=0.9364,0.1297,0.7228；P=0.4229,0.9424,0.5388）,而发病孕龄、分娩孕龄及保守治疗时间比较,差异均有统计学意义（F=396.3566,238.1611,207.1046；P=0.000）。4组各并发症发生率比较,差异均无统计学意义（χ2=7.3120,1.3473,0.4655,2.4863,2.5766,2.0771,4.3874,2.2610,20.6570；P＞0.05）。A组和 B 组围生儿死亡率、新生儿窒息和新生儿呼吸窘迫综合征（NRDS）发生率显著高于 C 组和D组,前二者分别和后二者比较,差异均有统计学意义（P＜0.05）,但 C组和D 组间比较,差异无统计学意义（P＞0.05）。结论重度先兆子痫孕妇发病孕龄与其保守治疗时间及并发症发生率无明显关系,而与围生儿结局有较密切关系,可以选择孕龄为32孕周作为判断早发型重度先兆子痫（EOSP）的临界值标准。

Relationship Between Onset Gestational Age and Materal and Perinatal Prognosis in Severe Preeclampsia

Objective To analyze the effects of severe preeclampsia at different gestational ages on the maternal and perinatal outcomes.Methods From January 2007 to October 2013,the clinical data of 468 severe preeclampsia patients were analyzed retrospectively in the study.According to their gestational weeks,they were divided into group A （n=75,gestational week〈28 weeks）,group B （n=99,28 weeks≤gestational week〈31＋6 weeks）,group C （n=84,32 weeks≤gestational week〈34 weeks）and group D （n=210,gestational week≥34 weeks）.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of First Affiliated Hospital of Guangxi Medical University.Informed consent was obtained from each participants.The maternal and perinatal outcomes among four groups were compared.Results There were no significant differences in age,systolic blood pressure,diastolic blood pressure among four groups （F=0.936 4,0.129 7,0.722 8;P=0.422 9,0.942 4,0.538 8）and no significant differences were found in incidence rates of complications among four groups （χ2 =7.312 0, 1.347 3,0.465 5,2.486 3,2.576 6,2.077 1,4.387 4,2.261 0,20.657 0;P＆gt;0.05）.The differences of gestational age at onset,gestational age at delivery and expectant treatment duration among four groups had statistically significant （F=396.356 6,238.161 1,207.104 6;P=0.000）.Perinatal mortality,the incidence rates of neonatal asphyxia and neonatal respiratory distress syndrome （NRDS）in group A and group B were significantly higher than those of group C and group D （P〈0.05 ）,but the differences were not found between group C and group D （P＆gt;0.05 ）.Conclusions The gestational age of the onset of severe preeclampsia and expectant treatment duration were unrelated to the maternal outcomes.Gestational week at 32 weeks may be the best critical value of diagnosis of early onset severe preeclampsia（EOSP）.