292例妊娠期高血压疾病相关因素及围生儿结局病例分析

发布时间：2018-06-30 10:11

本文选题：妊娠期高血压疾病 + 相关因素　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：了解妊娠期高血压疾病发生的流行病学相关因素以及该病对围生儿结局的不良影响，为该病的病因研究以及防治提供临床依据。方法：采用大样本回顾性分析的流行病学方法，选取2012年01月-2013年12月期间于北京军区总医院妇产科住院分娩妊娠期高血压疾病患者292人作为观察对象，选取同期住院分娩的正常孕妇作为对照。采集两组孕妇的相关参数：1、一般情况：产妇的年龄、分娩时孕龄、孕次、产次、胎儿性别、高血压家族史等；2、孕期并发症发生情况，如视网膜病变、妊娠期糖尿病、急性肺损伤、急性肾功不全、胎盘早剥、前置胎盘、妊高症性心脏病、脑血管意外、HELLP综合征等；3、分娩结局：分娩孕周、分娩方式、产后出血、产后贫血等；4、围生儿结局：出生低体重、胎儿窘迫、新生儿窒息、围生儿死亡等。采用独立样本t检验、χ2检验等研究与妊娠期高血压疾病发生相关的危险因素，以及该病对妊娠结局和围生儿结局的影响。结果：1、与妊娠期高血压疾病发生相关的危险因素分析：（1）观察组和对照组孕妇平均年龄分别为（30.56±4.35）岁和(25.0±3.13)岁，，前者显著大于后者（P＜0.05）；两组孕妇年龄大于35岁的比例分别为15.41%和3.42%，差异也有统计学差异（P＜0.05）；（2）观察组和对照组孕妇孕前体重指数分别为(27.31±1.89)和(23.45±2.11)，两组比较，前者显著大于后者（P＜0.05）；（3）观察组和对照组孕妇有高血压家族史的比例分别为26.03%和5.82%，两组比较，前者显著高于后者（P＜0.05）；（4）观察组孕妇围生期视网膜病变、妊娠期糖尿病、急性肺损伤、急性肾功不全、胎盘早剥、前置胎盘的发生率分别为10.62%、7.19%、4.11%、3.42%、2.74%和2.05%，对照组孕妇围生期上述病变发生率均为0，两组比较，差异均有统计学意义（P＜0.05）。2、妊娠期高血压疾病对分娩结局的影响：观察组孕妇早产、足月产、剖宫产、阴道分娩、产后出血、产后贫血的发生率分别为42.81%、57.19%、90.41%、9.59%、6.85%和16.44%，对照组孕妇上述发生率分别为14.04%、85.96%、43.49%、56.51%、0.34%和5.14%。两组比较，差异均有统计学意义（P＜0.05）。3、妊娠期高血压疾病对围生儿结局的影响：观察组新生儿低体重儿、胎儿窘迫、新生儿窒息和围生儿死亡发生率分别为10.96%、5.14%、5.82%和1.37%，对照组孕妇上述发生率分别为2.74%、1.37%、1.03%和0.00%，两组比较，差异均有统计学意义（P＜0.05）。结论： 1、高龄（大于35岁）可能是妊娠期高血压疾病发病的危险因素； 2、孕前肥胖可能是妊娠期高血压疾病发病的危险因素； 3、高血压家族史可能是妊娠期高血压疾病发病的危险因素； 4、某些孕期和围生期并发症可能与妊娠期高血压疾病互为因果，互相加重其病理过程； 5、妊娠期高血压疾病可导致不良分娩结局和不良围生儿结局，对其分娩时机、分娩方式的把握有利于改善围生期预后。
[Abstract]:Objective: to investigate the related epidemiological factors of hypertensive disorder complicating pregnancy and the adverse effects of the disease on perinatal outcome, so as to provide the clinical basis for the study of the etiology and prevention of the disease. Methods: a total of 292 pregnant women with hypertension complicating pregnancy were selected from January 2012 to December 2013 in Beijing military region General Hospital from January 2012 to December 2013. Normal pregnant women who were given birth in hospital at the same time were selected as control. The related parameters of two groups of pregnant women were collected: age of parturient, gestational age at parturition, pregnancy, delivery, fetal sex, family history of hypertension, and complications during pregnancy, such as retinopathy, gestational diabetes mellitus, and so on. Acute lung injury, acute renal insufficiency, placental abruption, placenta previa, PIH heart disease, cerebrovascular accident and HELLP syndrome, etc. 4, perinatal outcome: low birth weight, fetal distress, neonatal asphyxia, perinatal death and so on. Independent sample t test and 蠂 2 test were used to study the risk factors associated with hypertensive disorder complicating pregnancy and the influence of the disease on pregnancy outcome and perinatal outcome. Results: (1) the mean age of pregnant women in the observation group and the control group were (30.56 卤4.35) years and (25.0 卤3.13) years, respectively, which were significantly higher than the latter (P < 0.05). The percentage of pregnant women over 35 years old in the two groups was 15.41% and 3.42, respectively, and the difference was also statistically significant (P < 0. 05). The body mass index of pregnant women in the observation group and the control group were (27. 31 卤1. 89) and (23. 45 卤2. 11), respectively. The former group was significantly higher than the latter group (P < 0. 05). (3) the proportion of pregnant women with family history of hypertension was 26.03% in the observation group and 5.82% in the control group. The former group was significantly higher than the latter group (P < 0. 05); (4). In the observation group, the incidence of perinatal retinopathy, gestational diabetes mellitus and acute lung injury were significantly higher than those in the control group (P < 0. 05). The incidence of acute renal insufficiency, placental abruption and placenta previa were 10.627.19% and 2.05%, respectively. The difference was statistically significant (P < 0.05). 2. The effect of hypertensive disorder complicating pregnancy on the outcome of delivery: premature delivery, term delivery, cesarean section, vaginal delivery and postpartum hemorrhage in the observation group. The incidence of postpartum anemia was 42.81% and 9.595.85% and 16.4445%, respectively. The above rates of pregnant women in the control group were 14.0455.96and 43.495.490.34% and 5.14%, respectively.The results showed that the incidence of postpartum anemia was 0.34% and 16.44%, respectively, and that of the pregnant women in the control group was 0.34% and 5.14%, respectively. There were significant differences between the two groups (P < 0.05). 3. The effect of hypertensive disorder complicating pregnancy on perinatal outcome: low birth weight newborn, fetal distress, The incidence of neonatal asphyxia and perinatal death was 10.96 5.14% and 1.37%, respectively, while that of the control group was 1.37% and 1.73%, respectively. The difference between the two groups was statistically significant (P < 0.05). Conclusion: (1) Old age (older than 35 years) may be the risk factor of hypertensive disorder complicating pregnancy, 2, obesity before pregnancy may be the risk factor of hypertensive disorder complicating pregnancy. (3) the family history of hypertension may be the risk factor of hypertensive disorder complicating pregnancy, 4, some complications during pregnancy and perinatal period may be causality with hypertensive disorder complicating pregnancy, and the pathological process of hypertension complicating pregnancy may be aggravated by each other. 5. Hypertensive disorder complicating pregnancy can lead to bad delivery outcome and bad perinatal outcome. It is helpful to improve the perinatal prognosis by grasping the delivery time and delivery mode.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.246

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