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目的探讨重度子痫前期患者终止妊娠时间对母儿预后的影响。方法回顾分析2003-1—2008-12,我院妇产科收治的91例重度子痫前期患者的资料,按入院确诊至终止妊娠的时间分为三组。A组:确诊后24h终止妊娠,B组:确诊后24-48h终止妊娠,C组:确诊后>48h终止妊娠。对三组患者母儿预后进行分析。结果(1)三组患者实验室检查均提示有凝血功能及肝肾功能障碍,三组患者间终止妊娠前低蛋白血症及蛋白尿发生率比较差异有显著性意义(P<0.05)。(2)C组患者HELLP综合征发生率低,与其他两组比较差异有显著性意义(P<0.05)。(3)三组围生儿结局比较,C组胎儿生长受限(FCR)及早产儿发生率最高,分别是48.6%和68.6%。(4)三组间分娩方式的比较差异有显著性意义(P<0.05),三组患者剖宫产率均高于阴道分娩率,C组剖宫产率达91.4%。结论重度子痈前期患者应根据病情轻重、发病孕周及胎儿宫内状况采取个体化的治疗方案,选择恰当的时机终止妊娠,能取得较好的母婴结局。保守治疗时应实施严密监护。
Objective To investigate the effect of termination of pregnancy on prognosis in patients with severe preeclampsia. Methods The data of 91 patients with severe preeclampsia treated in our department from January 2003 to December 2008 were retrospectively analyzed. The patients were divided into three groups according to the time from admission to termination of pregnancy. Group A: Pregnancy termination 24 h after diagnosis, Group B: termination of pregnancy 24-48 h after diagnosis, Group C: termination of pregnancy> 48 h after diagnosis. The prognosis of three groups of patients were analyzed. Results (1) All the three groups of patients showed coagulation function and liver and kidney dysfunction. There was significant difference in the incidence of hypoproteinemia and proteinuria between the three groups before termination of pregnancy (P <0.05). (2) The incidence of HELLP syndrome in group C was lower than that in other two groups (P <0.05). (3) Compared with the results of three groups of infants, the incidence of fetal growth restriction (FCR) and premature infants in group C were the highest (48.6% and 68.6%, respectively). (4) There was a significant difference in the mode of delivery among the three groups (P <0.05). The cesarean section rate in all three groups was higher than vaginal delivery rate, and the rate of cesarean section in group C was 91.4%. Conclusions Patients with severe preeclampsia should adopt individualized treatment plan according to severity, gestational gestational age and intrauterine fetal status. Choosing the right time to terminate the pregnancy can achieve a better maternal-infant outcome. Conservative treatment should be closely monitored.