208例妊娠期肝内胆汁淤积综合症临床分析

目的 探讨如何及时发现胎儿羊水粪染, 适时终止, 对妊娠期肝内胆汁淤积综合症围产儿结局的影响.方法 对云南省昭通市第一人民医院产科收治的2012年12月至2015年12月208例ICP病例进行回顾性研究, 将其分为:实验组 (ICP组) 208例, 对照组 (非ICP组) 为同期分娩人数10 890例 (非ICP组) .均对其进行如下处理: (1) 胎儿监测; (2) 肝功能、胆汁酸、凝血四项检查; (3) 选择性羊膜腔穿刺或人工破膜了解羊水性状; (4) 终止妊娠时机的选择; (5) 分娩方式的选择;并对照2组的羊水胎粪污染率、早产率及围生儿死亡率.结果 实验组早产50例 (24.04%, 50/208) , 剖宫产120例 (57.69%, 120/208) .实验组羊水粪染63例 (30.29%, 63/208) , 自然破膜者发现3例, 羊膜腔穿刺术中发现5例, 剖宫产术中发现10例, 人工破膜45例.对照组早产1214例 (11.15%, 1214/10 890) , 剖宫产3424例 (31.44%, 3424/10 890) , 羊水胎粪污染814例 (7.41%, 814/10 890) .ICP病例组早产率、剖宫产率、羊水污染率高于对照组, 差异有统计学意义 (P<0.05) .结论 尽早发现胎儿羊水粪染及适时终止, 对降低妊娠期肝内胆汁淤积综合症患者围生儿死亡率及病死率有重要的临床意义.

An Analysis of the Outcome of 208 Cases of Intrahepatic Cholestasis in Pregnancy

Objective To investigate the effects of amniotic fluid meconium contamination and timely termination of pregnancy on perinatal outcome of intrahepatic cholestasis of pregnancy (ICP) . Me thods From December 2012 to December 2015, 208 cases of ICP were selected in the Department of Obstetrics of the First People's Hospital of Zhaotong City, Yunnan Province. The retrospective study included two groups: the experimental group with 208 cases (ICP group) and the control group with10890 normal deliveries (non-ICP group) . They were treated as follows: (1) fetal monitoring; (2) tests of liver function, bile acid and coagulation; (3) selective amniocentesis or artificial membrane ruptured amniotic fluid traits; (4) determination of the timing of the termination; (5) the choice of gestation mode and the control of the amniotic fluid meconium contamination rate, premature birth rate and perinatal mortality. Re s ults Sixty-three cases (30.29%) of amniotic fluid meconium were found in ICP group including 5 cases of amniocentesis, 45 cases of artificial rupture of membranes, 10 cases of cesarean section and 3 cases of natural rupture. Preterm birth was 50 cases (24.04%) and cesarean section was120 cases (57.69%) . In the control group, there were 814 cases of amniotic fluid meconium (7.41%) , 1214 cases of preterm birth (11.15%) and 3424 cases (31.44%) of cesarean section. The rates of amniotic fluid infection, preterm birth and cesarean section in ICP patients were significantly higher than those in the control group (P <0.05) . Conclusion Important clinical value is observed in early detection of amniotic fluid meconium contamination and timely termination of pregnancy to reduce perinatal mortality among ICP patients.