论文部分内容阅读
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14 127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%(121/14 127)。(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。
Objective To analyze the maternal and neonatal outcomes of patients with chronic hypertension complicated by pregnancy and to explore the risk factors of poor prognosis in maternal and child. Methods From January 2000 to December 2005, Peking University First Hospital delivered 14 127 pregnant women, including 121 cases of chronic hypertension complicated by pregnancy. The patients were divided into preeclampsia group (PE group, 64 cases) The preeclampsia group (N-PE group, n = 57) was used to analyze the maternal and infant outcomes of the two groups to find out the risk factors for the poor prognosis of maternal and child. Results (1) The incidence of chronic hypertension complicated with pregnancy was 0.86% (121/14 127). (2) The incidence of placental abruption, pulmonary edema and retinopathy were 16% (10/64), 11% (7/64) and 41% (26/64) in PE group, respectively 2% (1/57), 0% and 16% (9/57) respectively. There were significant differences between the two groups (P <0.05). (3) Preterm birth rate and preterm birth rate <32 weeks: 55% (35/64) and 27% (17/64) in PE group and 16% (9/57) and 2% 1/57). There was significant difference between the two groups (P <0.01). (4) The incidence of small gestational age (SGA) was 31% (20/64) in PE group and 7% (4/57) in N-PE group, the difference was statistically significant (P <0.01 ). (5) Perinatal mortality and neonatal intensive care unit incidence rates were 11% (7/64) and 33% (21/64) in the PE group and 0 and 5% (3) in the N-PE group / 57). There was significant difference between the two groups (P <0.01). (6) Univariate analysis showed that chronic hypertension history ≥ 4 years, no systematic treatment, undetermined prenatal examination and a history of preeclampsia were the risk factors affecting the outcome of maternal and infant preeclampsia with chronic hypertension (P < 0.05). Multivariate logistic regression analysis showed that only the history of chronic hypertension ≥ 4 years was an independent risk factor affecting the outcome of maternal and infant preeclampsia with chronic hypertension (P <0.05). Conclusion The maternal morbidity and perinatal mortality in patients with chronic hypertension and preeclampsia are significantly higher than those without preeclampsia. A history of chronic hypertension ≥ 4 years is an independent risk factor leading to chronic hypertension with preeclampsia.