妊娠期高血压疾病相关危险因素及母婴结局的临床分析

发布时间：2019-05-18 22:36

【摘要】：目的:研究妊娠期高血压疾病发病的相关危险因素及不良妊娠结局,探讨妊娠期高血压疾病的合理治疗,为临床医生诊治该病提供临床指导意义。方法:采用大样本回顾性分析的研究方法,收集2015年1月至2016年12月就诊于兰州大学第一医院妇产科,明确诊断为妊娠期高血压疾病,同时顺利分娩的孕产妇436例作为观察组,另随机选择同一时间段在该院妇产科住院分娩,且孕期的各项临床检验指标均正常的孕妇436例作为对照组。详细收集两组孕妇的一般情况、分娩结局、围生儿结局、临床检验指标(血常规、凝血功能)等信息。采用独立样本t检验、χ2检验及多因素非条件Logistic回归分析的统计学方法进行数据分析。结果:1.平均年龄方面,观察组的均值大于对照组,两组相比,差异有统计学意义;其中孕妇年龄≥35岁的,两组比例分别为44.50%、36.24%,差异也有统计学意义;2.双胎妊娠,两组比例分别为13.30%、4.82%,差异有统计学意义;3.IVF-ET术后,观察组的比例为16.51%,对照组为6.65%,两组比较,差异有统计学意义;4.规范产检,两组比例分别为52.06%、68.35%,差异有统计学意义;5.文化水平(大专及以上),两组比例分别为40.60%、56.20%,差异有统计学意义;6.肥胖(孕前BMI≥28kg/m2),两组比例分别为50.23%、43.12%,差异有统计学意义;7.白细胞计数及其分类(淋巴细胞、中性粒细胞),疾病组平均值均大于正常妊娠组,两两相比,差异均有统计学意义;轻度子痫前期组与重度子痫前期组的白细胞计数及其分类的均值比较,差异无统计学意义;8.凝血功能方面,疾病组PLT、PT、APTT、TT的均值均小于正常妊娠组,FIB的平均值大于正常妊娠组,差异均有统计学意义;轻度子痫前期组PLT、PT、APTT、TT的均值均小于重度子痫前期组,FIB的平均值大于重度子痫前期组,差异也有统计学意义;9.将上述有意义的单因素纳入多因素非条件Logistic回归模型分析显示,高龄、双胎妊娠、试管婴儿、孕前BMI、白细胞、中性粒细胞、PLT、PT、FIB是HDCP发病的危险因素;而规范产检和文化水平是HDCP的保护性因素;10.早产、剖宫产、产后出血的发生率,疾病组分别为38.30%、62.61%、31.65%,正常妊娠组分别为21.10%、47.25%、17.43%,两两相比,差异有统计学意义;11.疾病组新生儿的胎儿生长受限、胎儿窘迫、新生儿窒息和围产儿死亡的发生率分别为22.25%、33.72%、16.51%和4.13%,正常妊娠组新生儿的上述围生期结局的发生率分别为12.39%、22.02%、8.49%、0.46%,两组比较,差异有统计学意义;结论:1.高龄(年龄≥35岁)、多胎受孕、试管婴儿、肥胖等为妊娠期高血压疾病发病的危险因素;2.白细胞计数及其分类与妊娠期高血压疾病的发病存在着一定相关性;3.PLT、PT、FIB可反映妊娠期高血压疾病的严重程度,监测妊娠期高血压疾病患者的血小板指标及凝血功能可及时了解病情的进展趋势,能提早预防严重并发症的发生,减少不良妊娠结局;4.目前为止,除了终止妊娠外,还没有有效的PE治疗。因此,PE的可靠预测因素将在早期预防和干预中发挥重要作用,但其可靠预测因素还需进一步挖掘。
[Abstract]:Objective: To study the related risk factors and the adverse pregnancy outcome of hypertensive disorder during pregnancy, and to explore the reasonable treatment of hypertensive disorder during pregnancy and to provide the clinical guidance for the diagnosis and treatment of the disease. Methods: The method of retrospective analysis of large samples was used to collect and collect the gynaecology and obstetrics from January 2015 to December 2016 in the first hospital of Lanzhou University. A total of 436 pregnant women were randomly selected for the same time period in the hospital and obstetrics and gynecology in the hospital, and 436 of the normal pregnant women were used as the control group. The general situation, delivery outcome, perinatal outcome, clinical examination index (blood routine, coagulation function) of two groups of pregnant women were collected in detail. The data were analyzed by the independent sample t-test, the second-order test and the statistical method of multi-factor non-conditional logistic regression analysis. Results:1. In the mean age, the mean value of the observation group was greater than that of the control group, and the difference was statistically significant in the two groups. The proportion of the two groups was 44.50% and 36.24%, respectively. The proportion of the two groups was 13.30% and 4.82%, respectively. The proportion of the observation group was 16.51% after IVF-ET and 6.65% in the control group. The proportion of the two groups was 52.06% and 68.35%, respectively. The cultural level (college degree and above), the proportion of the two groups were 40.60% and 56.20%, respectively. The proportion of pregestational BMI (28 kg/ m2) was 50.23% and 43.12%, respectively. The white blood cell count and its classification (lymphocytes, neutrophils) and the mean value of the disease group were all higher than that of the normal pregnancy group, and the difference was statistically significant. The white blood cell count of the mild preeclampsia group and the severe preeclampsia group and the mean value of the classification were compared. The difference was not statistically significant;8. The mean value of PLT, PT, APTT and TT of the disease group was lower than that of the normal pregnancy group. The mean value of PLT, PT, APTT and TT in the preeclampsia group was less than that of the severe preeclampsia group. The mean value of FIB was greater than that of the severe preeclampsia group, and the difference was also statistically significant. The above-mentioned single factors were included in the multi-factor non-conditional logistic regression model. The risk factors of the incidence of HDCP in the elderly, the twin pregnancy, the test tube, the pre-pregnancy BMI, the white blood cell, the neutrophils, PLT, PT and FIB were the protective factors of the HDCP. 10. The incidence of prematurity, cesarean section and postpartum hemorrhage was 38.30%, 62.61%, 31.65%, respectively, and the normal pregnancy group was 21.10%, 47.25% and 17.43%, respectively. The incidence of fetal distress, neonatal asphyxia and perinatal death was 22.25%, 33.72%, 16.51% and 4.13%, respectively. The incidence of the perinatal outcomes in the normal pregnant group was 12.39%, 22.02%, 8.49% and 0.46%, respectively. The difference is of statistical significance; conclusion:1. The risk factors of high-age (35-year-old), multiple-birth pregnancy, test-tube infants, and obesity are the risk factors for hypertensive diseases during pregnancy. The blood cell count and its classification have a certain correlation with the incidence of hypertensive disorder during pregnancy.3. PLT, PT, FIB can reflect the severity of the hypertensive disorder during pregnancy, and the platelet index and the coagulation function of the patients with hypertensive disorder during pregnancy can be well informed of the progress of the disease. the occurrence of serious complications can be prevented early, and the adverse pregnancy outcome can be reduced; So far, there is no effective PE treatment in addition to the termination of pregnancy. As a result, the reliable predictor of PE will play an important role in early prevention and intervention, but its reliable predictor needs to be further mined.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.246

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