十年间重度先兆子癎处理变化与母儿预后(附654例分析)

目的了解10年来我院对重度先兆子癎处理的改变与母儿预后的关系。方法收集我院1999年1月至2003年12月(后5年)重度先兆子癎病例资料305例,将其并发症与处理、分娩方式及围产儿预后,与前5年349例(1994年1月至1998年12月)资料进行对比性分析。结果早发型重度先兆子癎(<34周)后5年占28．9％(88／305),前5年为10．6％(37／349),差异有统计学意义(P<0．01)。后5年中≤34周者行促胎肺成熟治疗占76．5％(78／102),明显高于前5年的11．1％(6／54,P<0．01)。后5年<34周的致死性引产显著减少,分别为30．3％(10／33)和7．9％(7／88),P<0．01。前后5年围产儿死亡率为8．49％(31／365)与10．56％(34／322),差异无统计学意义(P>0．05),但后5年<34周围产儿死亡率明显降低,分别为29．5％(26／88)和69．7％(23／33),P<0．01。外院转来患者平均终止孕周明显小于在本院保健患者(P<0．05),且其母儿并发症明显增多(P<0．05)。结论加强孕期保健、母儿监护,对<34周早发型重先兆子癎可减少致死性引产,促胎肺成熟,适时终止妊娠,密切产儿科合作,有望减少母儿并发症、降低孕产妇和围产儿死亡率。

Changes in management of 654 cases of severe preeclampsia and the maternal and perinatal outcomes

Objective To compare the changes in the management of severe preeclampsia during a ten-year period, and the maternal and perinatal outcome. Methods Totally, 305 cases of severe preeclampsia were collected in our hospital from January 1999 to December 2003. The management, mode of delivery, frequency of complications and maternal and fetal outcomes were compared with the 349 cases from January 1994 to December 1998. Results The incidence of severe preeclampsia, that being diagnosed at <34 gestation from 1999 to 2003 was higher than that from 1994 to 1998 [28. 9% (88/305) vs 10. 6% (37/349) ,P<0. 01]. The number of cases using dexamethesone for fetal lung maturity during 1999-2003 was significantly more than that of the former 5-year period [76. 5% (78/ 102) vs 11. l%(6/54), P<0. 01] and the medical induction rate was significant lower [30. 3% (10/ 33) vs 7. 9% (7/88) , P<0. 01]. Decreased perinatal mortality rate was found in the later stage without statistical difference [8. 49% (31/365) vs 10. 56%(34/322), P>0. 05], but the perinatal mortality rate of those cases <34 gestational weeks during 1999-2003 was significantly lower than that of cases from 1994 to 1998 [29. 5%(26/88) vs 69. 7%(23/33) , P<0. 01]. The termination of the pregnancies for those women transferred from other hospitals was earlier than those who had prenatal care in our hospital and had higher rate of complications (P<0. 05). Conclusions The incidence of severe complications of mothers and infants, maternal and perinatal mortality rate can be reduced by better antenatal care.