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目的探讨妊娠期高血压疾病严重并发症的发生规律及其对孕产妇和围产儿的影响。方法对1995—2004年南方医科大学南方医院、珠江医院、广州市第二人民医院和广州市番禺区何贤纪念医院共71020例孕妇中的4107例妊娠期高血压疾病患者的临床资料进行回顾性分析。结果(1)妊娠期高血压疾病发生率:为5.78%(4107/71 020),其中重度子痫前期为27.78%(1141/4107),轻度子痫前期为72.22%(2966/4107)。(2)妊娠期高血压疾病严重并发症发生率:胎盘早剥为1.68%(69/4107),DIC 为1.36%(56/4107),妊娠期高血压疾病性心脏病为1.05%(43/4107),肾功能衰竭为0.97%(40/4107),脑血管意外为0.58%(24/4107),溶血、肝酶升高、低血小板计数(HELLP)综合征为0.51%(21/4107)。(3)孕产妇死亡:孕产妇均死于多重并发症,死亡率为0.19%(8/4107),死亡专率为11.26/10万(8/71020),死亡病例中,脑血管意外4例次(17%,4/24),HELLP综合征2例次(10%,2/21),DIC 3例次(5%,3/56),妊娠期高血压疾病性心脏病1例(2%,1/43)。(4)围产儿死亡:围产儿死亡率为3.01%(130/4319)。死亡病例中,孕产妇发生胎盘早剥33例(43%,33/77),HELLP 综合征10例(42%,10/24),DIC 22例(34%,22/64),肾功能衰竭11例(25%,11/44),脑血管意外6例(24%,6/25),妊娠期高血压疾病性心脏病8例(16%,8/49)。结论 (1)妊娠期高血压疾病严重并发症的发生率由高到低依次为:胎盘早剥、DIC、妊娠期高血压疾病性心脏病、肾功能衰竭、脑血管意外、HELLP 综合征。(2)致孕产妇死亡的并发症依次为:脑血管意外、HELLP 综合征、DIC 和妊娠期高血压疾病性心脏病。(3)致围产儿死亡的孕妇并发症依次为:胎盘早剥、HELLP综合征、DIC、肾功能衰竭、脑血管意外和妊娠期高血压疾病性心脏病。
Objective To investigate the incidence of severe complications of hypertensive disorder complicating pregnancy and its effects on pregnant women and perinatals. Methods The clinical data of 4107 patients with gestational hypertension in 71020 pregnant women from Southern Hospital of Southern Medical University, Zhujiang Hospital, Second People ’s Hospital of Guangzhou City and He Xian Memorial Hospital of Panyu District from 1995 to 2004 were retrospectively reviewed analysis. Results (1) The incidence of hypertensive disorders in pregnancy: 5.78% (4107/71 020), of which 27.78% (1141/4107) in severe preeclampsia and 72.22% (2966/4107) in mild preeclampsia. (2) The incidence of serious complications of hypertensive disorders in pregnancy: 1.68% (69/4107) for placental abruption, 1.36% (56/4107) for DIC, 1.05% (43 / 4107), renal failure was 0.97% (40/4107), cerebrovascular accident was 0.58% (24/4107), hemolysis and liver enzymes were elevated, and HELLP syndrome was 0.51% (21/4107) . (3) Maternal deaths: Both maternal deaths were caused by multiple complications, with a mortality rate of 0.19% (8/4107) and a death rate of 11.26 / 100000 (8/71020). Among the deaths, 4 were cerebrovascular accidents (17%, 4/24), 2 cases of HELLP syndrome (10%, 2/21), 3 cases of DIC (5%, 3/56), 1 case of hypertensive disorder complicating heart disease %, 1/43). (4) Perinatal mortality: The perinatal mortality rate was 3.01% (130/4319). Among the deaths, 33 cases (43%, 33/77) had placental abortion in pregnant women, 10 cases (42%, 10/24) of HELLP syndrome, 22 cases (34%, 22/64) of DIC, renal failure 11 cases (25%, 11/44), 6 cases of cerebrovascular accident (24%, 6/25) and 8 cases of hypertensive disorder heart disease in pregnancy (16%, 8/49). Conclusions (1) The incidence of serious complications of hypertensive disorders in pregnancy from high to low were: placental abruption, DIC, hypertensive heart disease in pregnancy, renal failure, cerebrovascular accident and HELLP syndrome. (2) Complications of maternal mortality were as follows: cerebrovascular accident, HELLP syndrome, DIC and gestational hypertensive disorder. (3) The complications of pregnant women who caused perinatal death were as follows: placental abruption, HELLP syndrome, DIC, renal failure, cerebrovascular accident and gestational hypertensive disorder.