104例重度子痫前期患者母儿预后回访调查分析

发布时间：2018-02-15 06:09

本文关键词： 重度子痫前期妊娠结局产儿生长发育母亲长期预后　出处：《郑州大学》2014年硕士论文　论文类型：学位论文

【摘要】：背景与目的妊娠期高血压疾病（hypertensive disorders complicating pregnancy）是妊娠与血压升高并存的一组疾病，发病率约5%～8%，引起的孕产妇死亡约占妊娠相关死亡总数的10%～16%。该组疾病严重影响母婴健康，是孕产妇及围产儿病死率升高的主要原因，包括妊娠期高血压、子痫前期、子痫，以及慢性高血压并发子痫前期、慢性高血压合并妊娠。子痫前期（preeclampsia）指怀孕前血压正常的孕妇于妊娠20周后出现高血压、蛋白尿，在妊娠期高血压疾病中很常见，且是妊娠特发，可伴有心、脑、肾、肝等脏器功能损害，是导致孕产妇及围生儿患病率和死亡率升高的主要原因。查阅相关资料可以得知，近年来，很多医务工作者研究的重点聚焦于重度子痫前期（severe preeclampsia，sPE）的病因、发病机制等情况，但对于重度子痫前期患者较长期的预后情况及其子女的生长发育情况的跟踪调查在国内却鲜有报道，国外虽有研究，但因人种、地域等差异，可能与我国情况不完全相同，我国仍需我们自己民族的研究资料。本研究的目的如下： 1.比较正常孕产妇、早发型重度子痫前期（发病孕周≤34周，early onset severepreeclampsia,EOSP）及晚发型重度子痫前期（发病孕周＞34周，late onset severepreeclampsia，LOSP）患者及其所生新生儿的情况，探讨早发型及晚发型重度子痫前期患者所生婴儿结局与正常足月儿之间的差异。 2.比较我国正常学龄前儿童、早发型重度子痫前期及晚发型重度子痫前期患者所生子女（≤5岁）的生长发育情况，旨在了解三者之间的生长发育差异。 3.了解早发型重度子痫前期及晚发型重度子痫前期患者产后12周身体恢复情况，及此病对于患者的长期影响，并做一比较。通过以上三方面数据的收集及比较，指导临床医生对于不同发病孕周的重度子痫前期患者进行积极有效的救治，并提醒相关科室医生要关注重度子痫前期患者母儿日后生存健康问题，以期对于相关疾病做到一级预防。资料与方法收集2008年3月—2012年12月期间郑州大学第二附属医院产科收治的符合重度子痫前期诊断标准的104例单胎患者及其子女的资料，按重度子痫前期发病时间的不同，分为：早发型重度子痫前期（发病孕周≤34周），共47例，及晚发型重度子痫前期（发病孕周＞34周），共57例。并随机抽取同时期31例正常单胎孕产妇的临床资料，以及2009年9月卫生部妇幼保健与社区卫生司公布的《中国7岁以下儿童生长发育参照标准》作为对比。根据重度子痫前期患者入院时提供的联系方式，通过电话确认其是否愿意接受回访调查，征得同意后，采用电话回访的方式收集数据。其中，早发型重度子痫前期共收集到数据34人（回访率72.34%），晚发型重度子痫前期共收集到数据46人（回访率80.70%）。本调查研究共包括3部分：第一部分通过收集我院病案室已有的资料，比较31例正常产妇、47例早发型重度子痫前期及57例晚发型重度子痫前期患者所生新生儿的身长、体重，比较三组之间的差异；第二部分通过电话回访，收集到早发型重度子痫前期患者所生子女1～5岁数据分别6、8、5、0、6例，及晚发型重度子痫前期患者所生子女1～5岁数据分别14、3、8、10、11例，与2009年9月卫生部妇幼保健与社区卫生司公布的《中国7岁以下儿童生长发育参照标准》作为对照，比较三者之间的差异；第三部分通过电话回访，收集重度子痫前期患者血压等指标，了解其产后恢复情况，比较34例早发型及46例晚发型重度子痫前期患者远期结局。结果 1.正常足月儿、早发型及晚发型重度子痫前期新生儿出生情况三组婴儿中，早发型患者所生婴儿(＜3个月)死亡率达到23.4%，晚发型及正常者所生婴儿未见死亡情况。正常组婴儿出生时身长、体重等指标与早发型组及晚发型组比较，差异有统计学意义（P＜0.05）；晚发型组婴儿出生时身长、体重与早发型组比较，差异有统计学意义（P＜0.05）。 2.早发型及晚发型重度子痫前期患者所生子女（≤5岁）的生长发育情况早发型重度子痫前期患者所生的低出生体重儿（80.00%）及晚发型重度子痫前期患者所生的低出生体重儿(80.00%)于出生后1月～1周岁生长发育指标通过赶上生长达到国家标准。早发型、晚发型与正常儿童1～5岁身高（身长）、体重相比，除晚发型组与正常组5岁身高差异有统计学意义外（P＜0.05），余早发型组、晚发型组各年龄段身高（身长）、体重与正常组相比，差异均无统计学意义（P＞0.05）。 3.早发型及晚发型重度子痫前期患者的产后身体恢复情况早发型组中产后12周血压未恢复正常者12人(35.29%)，晚发型组中产后12周血压未恢复正常者7人(15.22%)，，早发型组及晚发型组产后12周血压恢复情况比较，差异有统计学意义（P＜0.05）。结论 1.早发型重度子痫前期患者所生婴儿死亡率较高，晚发型重度子痫前期患者子女出生结局好于早发型重度子痫前期患者子女，但差于正常足月儿。 2.对于重度子痫前期患者所生的低出生体重儿，无论早发型或晚发型，在出生后1个月～1周岁内多数生长发育指标能达到正常标准。 3.重度子痫前期患者子女在粗动作与平衡发展方面显示出不足，其中，早发型患者子女发生率更高。 4.早发型、晚发型重度子痫前期患者子女及我国正常儿童三者1～5周岁身体生长发育、智力等情况无明显差异。 5.早发型重度子痫前期患者较晚发型重度子痫前期患者产后更容易发生慢性高血压疾病。
[Abstract]:Background and purpose
Pregnancy induced hypertension (hypertensive disorders complicating pregnancy) is a group of diseases of pregnancy coexisting with elevated blood pressure, the incidence rate of about 5% to 8%, accounting for about 10% of the total number of deaths from pregnancy related deaths caused by maternal 16%. this disease seriously affecting maternal and child health, is a major cause of maternal and perinatal mortality, including pregnancy hypertension, preeclampsia, eclampsia, and chronic hypertension and pre eclampsia, chronic hypertension in pregnancy. Pre eclampsia (preeclampsia) refers to the normal blood pressure in pregnant women before pregnancy 20 weeks after the onset of hypertension, proteinuria, is common in hypertensive disorders in pregnancy, and pregnancy is idiopathic, with heart, brain, kidney, liver and other organ damage, is the leading cause of maternal and perinatal morbidity and mortality rate increased the main reason.
Access to relevant information that, in recent years, many medical workers are the focus of the study focused on severe preeclampsia (severe preeclampsia, sPE) the etiology, pathogenesis and other conditions, but for the follow-up survey of patients with severe preeclampsia than the long-term prognosis of children and the growth and development situation at home and abroad are rarely reported, although the study but, because of race, regional differences, possibly with the situation in our country is not exactly the same, it is necessary for China to study our own nation.
The purpose of this study is as follows:
1. normal pregnant women with early onset severe preeclampsia (gestational age less than 34 weeks, early onset severepreeclampsia, EOSP) and late onset severe preeclampsia (gestational weeks, 34 weeks, late onset severepreeclampsia, LOSP) patients and their neonates situation, explore the differences between the outcome of baby born in early and late onset in patients with severe preeclampsia and normal full-term infants.
2. comparison of China's normal preschool children, the children of early-onset severe preeclampsia and late onset severe preeclampsia (less than 5) growth and development, in order to understand the growth and development of the difference between the three.
3. understand the early recovery, severe preeclampsia and late-onset severe preeclampsia, 12 weeks postpartum physical recovery, and the long-term impact of this disease on patients, and make a comparison.
Through the collection and comparison of the above three aspects of data, guide clinicians to active and effective remedy for different gestational weeks with severe preeclampsia, health problems and related departments to remind doctors to survive on patients with severe preeclampsia maternal days after, in order to achieve the primary prevention of diseases related to materials and methods.
From March 2008 to December 2012 in the Second Affiliated Hospital of Zhengzhou University obstetrics treated with severe preeclampsia diagnosis of 104 cases of singleton patients and their children, according to the different time of onset of severe preeclampsia, divided into: early onset severe preeclampsia (gestational age less than 34 weeks), a total of 47 cases, and late onset severe preeclampsia early (gestational age > 34 weeks), a total of 57 cases. And the clinical data were randomly selected from the same period 31 cases of normal singleton pregnant women, the development of reference standard > as a comparative growth and in September 2009 the Ministry of health of maternal and child health care and community Health Department announced the "China children under the age of 7. According to the admission of patients with severe preeclampsia contact by telephone to confirm whether it is willing to accept a return visit survey, consent, data collected by telephone interviews. Among them, the early onset of severe preeclampsia were collected data 3 4 people (return rate of 72.34%), late onset severe preeclampsia collected data of 46 people (return rate of 80.70%).
This study includes 3 parts: through the collection of the Department of medical records for the first part, 31 cases of normal pregnant women, infants born in 47 cases of early onset severe preeclampsia and 57 cases of late onset severe preeclampsia patients with body height, body weight, compared the differences between the three groups; the second part through telephone interviews, collecting to the early onset of severe preeclampsia patients born 1~5 year old data were 6,8,5,0,6 cases, and late-onset preeclampsia children born 1~5 year old data were 14,3,8,10,11 cases, the development of reference standard > as control and growth announced in September 2009 the Ministry of health of maternal and child health care and community health department "Chinese children under 7 years of age, the difference between the three the third part; through telephone interviews, collecting the blood pressure of patients with severe preeclampsia, the postpartum recovery, 34 cases of early onset and late onset severe in 46 cases Long term outcome of patients with preeclampsia.
Result
1. normal foot months, early onset and late onset severe preeclampsia newborns
Three groups of infants, babies born early onset (< 3 months) the mortality rate reached 23.4%, the situation of late-onset and normal persons born baby no death. The normal group baby birth length, compared with early onset and late onset group weight index, the difference was statistically significant (P < 0.05); late hair infants birth length, compared with early onset group weight, the difference was statistically significant (P < 0.05).
2. children born in early and late onset severe preeclampsia (less than 5) the growth and development situation
Low birth weight infants with early onset severe preeclampsia (born 80%) low birth weight infants and late-onset preeclampsia (born 80%) was born after January to 1 years of growth and development indexes by catch growth reached the national standard. The early onset and late onset, normal children 1~5 years of age and height (length in addition, weight) compared with late onset group and the normal group of 5 years old height statistically significant difference (P < 0.05), more than the early onset group and late onset group at each age height (length), body weight compared with the normal group, there were no significant differences (P > 0.05).
Postpartum recovery in patients with 3. early onset and late onset severe preeclampsia
In the early onset group, 12 (35.29%) did not return to normal blood pressure at 12 weeks postpartum, and 7 (15.22%) did not return to normal blood pressure in the late-onset group at 12 weeks postpartum. There was a significant difference in blood pressure recovery between the early onset group and the late onset group at 12 weeks postpartum (P < 0.05).
conclusion
1. the early-onset severe preeclampsia has a higher infant mortality rate, and the late onset severe preeclampsia children's birth outcomes are better than those of the early onset severe preeclampsia children, but worse than the normal term infants.
2., for the low birth weight infants born in severe preeclampsia, no matter early or late onset, most of the growth and development indicators can reach the normal standard within 1 months to 1 years after birth.
3. the children of severe preeclampsia have a deficiency in the development of rough and balanced development, of which the incidence of children in early onset patients is higher.
4. early hair style, late onset severe preeclampsia and three normal children in China were 1~5 weeks old, and there was no significant difference in intelligence.
5. early onset severe preeclampsia patients with late onset severe preeclampsia are more likely to have chronic hypertension after the postpartum period.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.244

【参考文献】