早发型重度子痫前期期待治疗探讨..docVIP

早发型重度子痫前期期待治疗探讨 陈丽霞△(综述),苑中甫*(审校) (郑州大学第一附属医院妇产科,郑州450052) 中图分类号:R714. 245　　　　　文献标识码:A　　　　　文章编号:1006-2084(2009)23-3597-04 　　摘要:早发型重度子痫前期目前尚无统一的临床时间界定,多以孕34周界定ES-PE。因其母体 并发症多和围生儿病死率高,如何处理成为临床医师面对的棘手问题,近年来众多学者提出了期待 治疗的方法。期待治疗是在严格选择病例的前提下,密切监测母婴病情变化,兼顾母儿利益的同时 尽量延长孕周,并适时终止妊娠,终止妊娠方法首选剖宫产。适当期限的期待治疗有助于改善母儿 结局。 关键词:早发型;重度子痫前期;期待治疗 ExpectantM anagem ent ofEarly Onset Severe Pre-eclampsia　CHEN Li-xia,YUAN Zhong-fu. (Depart- ment ofGynaecology andObstetrics, theFirstAffiliatedHosptial ofZhengzhou University,Zhengzhou450052, China) Abstract:The clinical delimitation of early onset severe preeclampsia(ES-PE)has not been unified. Now most of the scholars thinkES-PE happensbefore 34 weeks′gestation. It is characterized by the high inci- dence ofmaternal complications and perinatalmortality, and the complications occur early and severe, so it is difficult to handle. It is important to selectcases carefully and closemonitoring forexpectantmanagement.Ex- pectantmanagement can prolong gestation age and getbetter prenatal prognosis, in the balance ofmaternal- prenatal condition. The pregnancy termination should be in good timing and cesarean section is the first choice.The suitable duration of expectantmanagement can improvematernal-prenatal prognosis. Key words:Early onset; Severe preeclampsia; Expectantmanagement 　　子痫前期(preeclampsia, PE)是妊娠期特发的而且严重威胁母儿健康的一种病症,存在较高的致病率和病死率。尤其是重度子痫前期( severe pre-eclampsia, S-PE),常常伴有各种终末器官损害,引发胎盘早剥、子痫、肝肾功能损害、心力衰竭、肺水肿、高血压脑病、HELLP综合征(hemolysis, elevated liverenzymes, and low platelets syndrome)、视网膜脱离等 严重并发症,为我国孕产妇死亡的第二大病因。对于临近预产期的晚发型,及时终止妊娠是迅速有效的治疗措施;而对于距预产期为时较远的早发型(early onset severe preeclampsia,ES-PE),因胎儿未成熟,终止妊娠会带来较高的新生儿患病率和病死率,新生儿需要特殊监护的时间也长;而延长孕周有致 胎儿窘迫、胎死宫内的可能并且会增加母体患病率。针对这个两难问题,国内外学者提出了期待治疗的措施。本文就近年来针对ES-PE提出的期待治疗予以综述。 1　ES-PE的临床时间界定演变ES-PE的概念早在20世纪80年代末就被提出,并引起了国内外学者的研究兴趣,但目前仍无统一的界定。近年杨孜等[1]提出以32孕周作为ES-PE的界定,终止妊娠孕周是影响胎儿及新生儿病死率的主要因素,并且与发病孕周有关;以34孕周为界定,围生儿病死率只与终止妊娠孕周有关,而与发病孕周无关。故认为以32孕周为界值更能反映发病孕周与分娩结局的关系,也更能反映三级医疗机构的救治水平。目前临床上倾向于 将发生于34孕周以前的S-P