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本文报道妊娠期肾功能损害89例,发生率0.82%。妊娠合并原发病有重度妊高征59例,慢性肾炎22例,狼疮性肾炎(SLE)5例,产后出血、围产期心肌病、产褥中暑各1例.以妊娠合并肾史之肾损害程度最严重,妊高征肾损害在终止妊娠后肾功能都能迅速恢复正常,预后较好。产后出血等所致的急性肾功能衰竭(ARF)临床上虽少见,但预后极差.本文ARF发生率为9.0%,孕产妇病死率为4.5%,胎儿宫内窘迫为5.7%,死胎为13.6%,死产2.3%,新生儿死亡9.1%,总围产儿病死率为250‰,孕妇肾损害程度越严重,围产儿病死率越高,本文以肾炎及SLE对围产儿危害最大。妊娠期肾损害除按内科原则处理外,还要考虑到妊娠、分娩的生理特点,胎儿情况等综合判断终止妊娠的时机和方法。孕期Cr>141μmol/L为终止妊娠指征。
This article reports 89 cases of renal damage during pregnancy, the incidence of 0.82%. Pregnancy complicated by the primary disease in 59 cases of severe pregnancy-induced hypertension, 22 cases of chronic nephritis, lupus nephritis (SLE) in 5 cases, postpartum hemorrhage, perinatal cardiomyopathy, puerperal heat stroke in 1 case. The most serious degree of damage, pregnancy-induced hypertension renal damage after termination of pregnancy can quickly return to normal renal function, the prognosis is good. Acute renal failure (ARF) caused by postpartum hemorrhage is clinically rare, but the prognosis is very poor.The incidence of ARF in this article is 9.0%, maternal mortality rate is 4.5%, fetal distress is 5.7% and stillbirth is 13.6 %, Stillbirth 2.3%, neonatal death 9.1%, total perinatal mortality of 250 ‰, the more serious the degree of renal damage in pregnant women, the higher perinatal mortality, this article nephritis and SLE perinatal harm the most. In addition to the treatment of renal damage by medical principles, but also take into account the physiological characteristics of pregnancy, childbirth, fetus and other comprehensive judgment of the timing and method of termination of pregnancy. Cr> 141μmol / L during pregnancy is the indication of termination of pregnancy.