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目的了解10年来我院对重度先兆子癎处理的改变与母儿预后的关系。方法收集我院1999年1月至2003年12月(后5年)重度先兆子癎病例资料305例,将其并发症与处理、分娩方式及围产儿预后,与前5年349例(1994年1月至1998年12月)资料进行对比性分析。结果早发型重度先兆子癎(<34周)后5年占28．9％(88／305),前5年为10．6％(37／349),差异有统计学意义(P<0．01)。后5年中≤34周者行促胎肺成熟治疗占76．5％(78／102),明显高于前5年的11．1％(6／54,P<0．01)。后5年<34周的致死性引产显著减少,分别为30．3％(10／33)和7．9％(7／88),P<0．01。前后5年围产儿死亡率为8．49％(31／365)与10．56％(34／322),差异无统计学意义(P>0．05),但后5年<34周围产儿死亡率明显降低,分别为29．5％(26／88)和69．7％(23／33),P<0．01。外院转来患者平均终止孕周明显小于在本院保健患者(P<0．05),且其母儿并发症明显增多(P<0．05)。结论加强孕期保健、母儿监护,对<34周早发型重先兆子癎可减少致死性引产,促胎肺成熟,适时终止妊娠,密切产儿科合作,有望减少母儿并发症、降低孕产妇和围产儿死亡率。
Objective To understand the relationship between the changes of severe preeclampsia and the prognosis of maternal and infant in our hospital over the past 10 years. Methods A total of 305 cases of severe preeclampsia from January 1999 to December 2003 (after 5 years) were collected. The complications and treatment, delivery mode and perinatal outcome were compared with 349 cases in the first 5 years (1994 January to December 1998) data for comparative analysis. Results Early premature severe preeclampsia (<34 weeks) accounted for 28.9% (88/305) in 5 years and 10.6% (37/349) in the first 5 years, the difference was statistically significant (P <0. 01). In the latter 5 years ≤34 weeks, 76% (78/102) were obstetric and fetal lung maturation treatments, significantly higher than 11.1% (6/54, P <0.01) of the first 5 years. Fatal abortion within 34 weeks after 5 years was significantly reduced, with 30.3% (10/33) and 7.9% (7/88), respectively, P <0.01. The perinatal mortality rates in the first five years of follow-up were 8.49% (31/365) and 10.56% (34/322) respectively, with no significant difference (P> 0.05) The rates were significantly lower, 29.5% (26/88) and 69.7% (23/33), respectively, P <0.01. The average termination of gestational weeks in patients transferred from the outer court was significantly less than that of health care patients in our hospital (P <0.05), and the maternal and neonatal complications were significantly increased (P <0.05). Conclusions Intensive care during pregnancy and mother-child care can reduce the risk of premature birth in <34 weeks, reduce lethal induced labor, promote fetal lung maturity, timely termination of pregnancy, close cooperation in pediatrics, is expected to reduce maternal and child complications and reduce maternal and Perinatal mortality.