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目的探讨早发性重度子痫前期的临床时间界定及不同发病孕周早发性重度子痫前期的临床特点。方法将79例<34周发病的重度子痫前期按孕周分为三组:A组≤28周25例,B组28~32周33例,C组32~34周21例,比较三组的一般情况、起病时血压及尿蛋白、基础疾病、并发症、分娩方式及围生儿结局等指标。结果 A组48%合并有内科疾病,明显高于B、C组,其中以慢性高血压者为多;B组8例前孕有子痫前期病史,明显高于A组;入院时A组收缩压(180±27.6)mm Hg、舒张压(111±17.0)mm Hg,平均动脉压(134±19.7)mm Hg均明显高于B、C组;尿蛋白三组比较无统计学差异;A组全部有并发症,B组并发症发生率79%,C组45%,C组明显低于A、B组;其中胎儿胎盘循环不良(脐动脉舒张期血流缺如或反向者)发生率A组44%,B组18%,C组未发现,C组明显低于A、B组;A组活产12例,新生儿窒息率42%,B组活产30例,窒息率13%,C组活产20例,无一例窒息,A组胎儿或新生儿死亡率、新生儿窒息率均明显高于B、C组。结论以32周为界定值更能反映早发性重度子痫前期发病时间与临床经过的关系。28周前发病者多合并有内科基础病,复发风险高,应在初检时重视。28周后发病的早发性重度子痫前期宜谨慎入选期待治疗,但应高度警惕胎盘早剥发生。
Objective To explore the clinical definition of early-onset severe preeclampsia and the clinical features of early-onset severe preeclampsia at different gestational ages. Methods Seventy-nine patients with severe preeclampsia <34 weeks were divided into three groups according to gestational age: 25 cases in group A ≤ 28 weeks, 33 cases in group B between 28 and 32 weeks, 21 cases in group C between 32 and 34 weeks, The general situation, the onset of blood pressure and urinary protein, underlying diseases, complications, delivery methods and perinatal outcomes and other indicators. Results 48% of patients in group A had internal medicine disease, which was significantly higher than those in group B and C, among them, those with chronic hypertension were more. Group B had a history of preeclampsia before pregnancy, which was significantly higher than that of group A; (180 ± 27.6) mm Hg, diastolic blood pressure (111 ± 17.0) mm Hg, mean arterial pressure (134 ± 19.7) mm Hg were significantly higher than those in group B and group C. There was no significant difference in urinary protein between the three groups All with complications, the incidence of complications in group B 79%, 45% in group C, group C was significantly lower than in group A and group B; Incidence of fetal placenta poor circulation (umbilical artery diastolic blood flow absence or reverse) A group of 44%, B group 18%, C group was not found, C group was significantly lower than A, B group; A group of 12 live births, neonatal asphyxia 42%, B group of 30 live births, asphyxia 13% , C group of live births in 20 cases, without a case of asphyxia, A group of fetal or neonatal mortality, neonatal asphyxia were significantly higher than the B, C group. Conclusions The definition of 32 weeks can better reflect the relationship between the onset time of early-onset severe preeclampsia and clinical course. 28 weeks before the onset of the merger of medical basic disease, high risk of recurrence, should be valued at the initial examination. Early onset of severe eclampsia after 28 weeks should be carefully selected for treatment, but should be highly alert to the occurrence of placental abruption.