重度子痫前期并发腹水患者的妊娠结局

目的:探讨重度子痫前期并发腹水的临床特点、孕产期处理及妊娠结局。方法:对该院2006年1月～2010年1月间143例重度子痫前期患者的临床资料进行回顾性分析,根据有无腹水分为腹水组(38例)和无腹水组(105例),比较其临床特点。结果:两组孕妇年龄、产次比较差异无统计学意义(P>0.05);腹水组系统产前检查次数低于无腹水组(P<0.05);腹水组的收缩压和舒张压分别高于无腹水组(P<0.05);腹水组中32例(84.21%)行剖宫产,余6例经阴道分娩;腹水组平均终止妊娠时间为(33±4)周,无腹水组为(36±3)周,差异有统计学意义(P<0.05);两组中总蛋白、白蛋白、白/球比值、血肌酐、24 h尿蛋白差异均有统计学意义(P<0.05);15例孕妇出现严重并发症(39.47%),FGR发生率65%,死胎和新生儿死亡率42.5%,高于无腹水组(P<0.05)。结论:重度子痫前期并发腹水发病早、病情重,血压高,妊娠并发症多,尿蛋白出现早、数值高。应在严格掌握适应证并在严密的监护下,早期、系统、定期的产前检查,合理治疗并适时终止妊娠可改善妊娠结局。

Analysis of pregnancy outcome in women with severe preeclampsia complicated with ascites

Objective:To investigate the clinical characteristics,treatments and pregnancy outcome in women with severe preeclampsia complicated with ascites. Methods:A retrospective study was conducted on 143 severe preeclampsia mothers,presented in the Heji Hospital of Changzhi Medical College from Jan 2006 to Jan 2010,who were divided into two groups: 38 complicated with ascites(ascites group) and 105 without(non-ascites group)and the clinical characteristics were compared. Results:There was no significant difference in ages,gravidity between the two groups(P<0.05).The rate of systemic antenatal care in the ascites group was lower than that of the non-ascites group(P<0.05).The contractive blood pressure and diastolic blood pressure in the ascites group were higher than the non-ascites group(P<0.05).32 patients in the ascites group were terminated pregnancy by cesarean section and 6 by vaginal delivery.The average time of the termination of pregnancy was(33±4) weeks in ascites group,and(36±3) weeks in non-ascites group(P<0.05).There were differences in the total protein,albumin,white/ball ratio,serum creatinnine,24-hour urinary protein between the two groups(P<0.05).The incidence of serious maternal complication was 39.47%,the incidence of fetal growth retardation was 65% and the incidence of perinatal mortality was 42.5%,which was higher than that in non-ascites group,especially in the groups <34 weeks. Conclusion:The group with severe preeclampsia complicated with ascites was early onset and severe,with many gestational complications,uncontrolled hypertension and the urine protein appeared earlier and higher.So early,systematic and regular prenatal care,proper medical intervention and termination of pregnancy should be recommended to improve pregnancy outcome at suitable time by well selecting patients and monitoring accurately.