2008年北京协和医院收治子痫前期及子痫病例分析

目的探讨子痫前期及子痫患者的特点,以及孕期监测、治疗及减少其严重并发症的措施。方法分析2008年北京协和医院收治的有我院系统产前检查及非我院系统产前检查的妊娠期高血压疾病患者的临床特点。结果 2008年北京协和医院共收治分娩总数1,438例,其中有我院系统产前检查者1,346例。接受我院系统产前检查的孕妇合并子痫前期者28例(A组),无子痫、无孕妇严重并发症;早产12例(43%)、小于胎龄儿2例(7%)、新生儿窒息1例(4%);经阴道分娩6例;平均住院7.1 d,平均住院费用4,524元。非我院系统产前检查的孕妇子痫5例及子痫前期者48例,共53例(B组),早产40例(76%)、新生儿窒息9例(17%)、小于胎龄儿14例(26%)、新生儿围产期死亡5例(9%);合并胎盘早剥3例(6%)、视网膜剥离3例(6%)、颅内病变5例(9%);除1例因胎死宫内经阴道分娩,余均行剖宫产、5例行全麻手术;平均住院6.8 d,平均住院费用9,457元。A组患者均进行规范的产前检查,平均产检次数9.2次。B组患者平均产检次数为2.1,且产检不规范(8例未做任何产检,12例仅行超声检查,20例未进行血压监测和尿常规检查)。所有患者接受的是规范硫酸镁治疗,而B组转院前均未接受硫酸镁静脉推注或肌注。结论加强孕妇的系统产前检查的宣教,规范治疗妊娠期高血压疾病,改善新生儿预后,减少医疗费用。

Clinical analysis of the patients with pre-eclampsia or eclampsia in Peking Union Medical College Hospital in 2008

Objective： To analyze the characteristics of the patients with pre-eclampsia or eclampsia treated in Pe- king Union Medical College Hospital in 2008. Methods： All of eighty-one patients with pre-eclampsia or eclampsia who had their deliveries in this hospital in 2008 were studied. The patients were divided into two groups according to whether they had their prenatal cares in this hospital： group A （28, in this hospital） and group B （53, in other hospitals）. The data on prenatal cares, treatments, complications, pregnancy outcomes, the length of hospital stay and associated cost were analyzed. Results： The patients in group A had an average of 9.2 regular prenatal cares, while those in group B had only 2.1 prenatal cares in average （8 without any prenatal examinations, 12 with only ultrasonic exam- ination, 20 without blood pressure examination or routine urinalysis）. In our hospital, the patients had the standardized treatment of magnesium sulfate when indicated, while the doses of magnesium sulfate for the patients in group B were always insufficient before referred to this hospital. All patients in group A were diagnosed as pre-eclampsia, with no eclampsia found. Of the patients in group B, 5 were with eclampsia and 48 with pre-eclampsia. The rates of premature labor, small for gestational age and newborn asphyxia were 43%, 7% and 4%, respectively in group A, while 76%, 26% and 17%, respectively in group B. No severe complications were found in group A. However, 4 cases of placental abruption, 3 cases of retinal detachment, 9 cases of intracranial problems and 5 cases of perinatal deaths were found in group B. The average length of hospital stay and associated cost were 7.1 days and 4,524 RMB, respectively in group A, and 6.8 days and 9,457 RMB, respectively in group B. Conclusions： Regular prenatal cares, standardized treatment and proper referral could largely reduce the severe complications of pregnancy-induced hypertension disease.