慢性高血压合并妊娠患者的母儿结局及其影响因素

目的通过分析慢性高血压合并妊娠患者的母儿结局,探讨导致母儿不良预后的高危因素。方法2000年1月至2005年12月北京大学第一医院分娩产妇14127例,其中慢性高血压合并妊娠患者121例,分为慢性高血压并发子痫前期组（PE组,64例）和未并发子痫前期组（N-PE组,57例）,对两组患者的母儿结局进行分析,找出导致母儿不良预后的高危因素。结果（1）慢性高血压合并妊娠的发病率为0．86％（121／14127）。（2）胎盘早剥、肺水肿和视网膜病变的发生率：PE组分别为16％（10／64）、11％（7／64）和41％（26／64）,N-PE组分别为2％（1／57）、0和16％（9／57）,两组分别比较,差异均有统计学意义（P〈0．05）。（3）早产率和〈32周的早产率：PE组分别为55％（35／64）和27％（17／64）,N—PE组分别为16％（9／57）和2％（1／57）,两组分别比较,差异均有统计学意义（P〈0．01）。（4）小于胎龄儿（SGA）发生率：PE组为31％（20／64）,N-PE组为7％（4／57）,两组比较。差异有统计学意义（P〈0．01）。（5）围产儿病死率和新生儿转重症监护室的发生率：PE组分别为11％（7／64）和33％（21／64）,N-PE组分别为0和5％（3／57）,两组分别比较,差异有统计学意义（P〈0．01）。（6）单因素分析表明,慢性高血压病史≥4年、未系统治疗、未定期产前检查和有子痫前期病史等是影响慢性高血压并发子痫前期母儿结局的高危因素（P〈0．05）。而多因素logistic回归分析表明,只有慢性高血压病史≥4年是影响慢性高血压合并子痫前期母儿结局的独立危险因素（P〈0．05）。结论慢性高血压合并子痫前期患者的母儿病率和围产儿病死率明显高于未合并子痫前期者。慢性高血压病史≥4年是导致慢性高血压合并子痫前期的独立危险因素。

Maternal and perinatal prognosis of pregnancy with chronic hypertension and analysis of associated factors

OBJECTIVE: To analyze the pregnant outcome of women with chronic hypertension, and to investigate the high risk factors associated with harmful maternal and perinatal prognosis. METHODS: Of the 14 127 deliveries in Peking University First Hospital from Jan 2001 to Dec 2005, 121 pregnant women with chronic hypertension were identified and divided into two groups: chronic hypertension with and without preeclampsia (group PE, 64 cases; group N-PE, 57 cases). The maternal and perinatal outcomes of the two groups and the high risk factors for adverse maternal and perinatal prognosis were analyzed. RESULTS: (1) The incidence of pregnancy with chronic hypertension was 0.86% (121/14 127). (2) The incidences of placental abruption, pulmonary edema and retinopathy in groups PE and N-PE were 16% (10/64) vs 2% (1/57), 11% (7/64) vs 0 and 41% (26/64) vs 16% (9/57, P < 0.05). (3) Preterm birth rate and preterm birth rate before 32 weeks in groups PE and N-PE were 55% (35/64) vs 16% (9/57) and 27% (17/64) vs 2% (1/57, P < 0.01). (4) The rate of small for gestational age in groups PE and N-PE was 31% (20/64) vs 7% (4/57, P < 0.01). (5) The perinatal mortality and newborn intensive care unit (NICU) admission rate in groups PE and N-PE were 11% (7/64) vs 0 and 33% (21/64) vs 5% (3/57, P < 0.01). (6) Chronic hypertension history > or = 4 years, no systemic therapy, irregular perinatal care and preeclampsia history were high risk factors of preeclampsia superimposed on chronic hypertension (P < 0.05). Chronic hypertension history > or = 4 years was the only independent risk factor by multiple factors logistic regression analysis (P < 0.05). CONCLUSIONS: Maternal and perinatal morbidity and mortality are higher in chronic hypertension with preeclampsia than without preeclampsia. Hypertension history for at least 4 years is an independent risk factor.