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目的:探讨24h尿蛋白定量高低及其变化对早发型重度子痫前期(PE)实施期待治疗母婴结局的影响。方法:回顾分析2008年1月至2013年12月在温州医科大学附属第一医院住院期待治疗并分娩、发病孕周(280/7~336/7周)的94例重度PE患者的临床资料。根据入院24h尿蛋白定量分为两组:I组<5g(56例),II组≥5g(38例)。比较两组患者的临床特点及母婴结局。结果:Ⅰ、Ⅱ组患者的期待治疗时间分别为12.6和12.2天,85%患者经保守治疗后24h尿蛋白呈增长趋势。两组孕妇的严重并发症,包括胎盘早剥、HELLP综合征、低蛋白血症、胸腹水、FGR比较,差异无统计学意义(P>0.05),两组均无DIC、子痫及孕产妇死亡发生。(3)围产儿结局中,出生体重、出生孕周、Apgar评分、NICU住院时间、并发症(颅内出血、支气管肺发育不良、坏死性小肠结肠炎)比较,差异均无统计学意义(P>0.05);Ⅱ组的RDS发生率及入住NICU高于Ⅰ组,差异有统计学意义(P<0.05),两组围产儿死亡率均为5%。结论:对早发型重度PE伴蛋白尿的患者,不应将24h尿蛋白量或增长速率作为终止妊娠的单一指标,需结合孕周、临床症状、胎儿成熟度和实验室检查,在母体实施期待疗法条件良好的情况下,尽可能延长孕周以改善围生儿预后。
Objective: To investigate the effects of quantitative and quantitative 24 h urinary protein on maternal and infant outcomes in early onset severe preeclampsia (PE). Methods: The clinical data of 94 patients with severe PE admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2008 to December 2013 were prospectively treated and delivered. The gestational age (280/7 to 336/7 weeks) was retrospectively analyzed. Urine protein was divided into two groups on the basis of urinary protein intake at admission: group I <5g (56 cases) and group II> 5g (38 cases). The clinical features and maternal and infant outcomes were compared between the two groups. Results: The expectant treatment time of patients in group Ⅰ and Ⅱ were 12.6 and 12.2 days, respectively. Urinary protein was increased in 24 hours after conservative treatment in 85% of patients. There were no significant differences between the two groups in the serious complications of placenta accreta, including placental abruption, HELLP syndrome, hypoalbuminemia, pleural, ascites and FGR (P> 0.05), no DIC, eclampsia and maternal Death happened. (3) There was no significant difference in birth weight, gestational age at birth, Apgar score, NICU length of hospital stay, complications (intracranial hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis) (P> 0.05). The incidence of RDS and admission NICU in group Ⅱ were significantly higher than those in group Ⅰ (P <0.05). The perinatal mortality rate in both groups was 5%. CONCLUSIONS: Patients with early-onset severe PE with proteinuria should not be given a single indicator of termination of pregnancy for 24-h urinary protein or growth rate, expecting to be employed in the mother in combination with gestational age, clinical symptoms, fetal maturity, and laboratory tests Treatment conditions are good, as long as possible to extend gestational age to improve perinatal outcome.