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目的探讨经阴道分娩和剖宫产分娩方式对重度妊娠期高血压疾病合并胎儿生长受限母婴结局的影响。方法选择2012年3月-2016年2月解放军一七四医院产科收治的114例重度妊娠期高血压疾病合并胎儿生长受限的单胎产妇为研究对象,经阴道分娩的53例产妇为对照组,剖宫产分娩的61例产妇为观察组。观察两组产妇的收缩压(SBP)、舒张压(DBP)、妊娠结局和新生儿动脉血、静脉血血气指标及体重、窒息发生率、死亡率等指标。结果观察组产妇的SBP、DBP明显低于对照组,差异有统计学意义(P<0.01);产后2 h出血量、并发症发生率均明显低于对照组,差异有统计学意义(P<0.05)。观察组新生儿脐动脉血、碳酸氢根(HCO_3~-)、血细胞比容(HCT)与对照组新生儿比较差异无统计学意义(P>0.05);但氧气分压(PO_2)、二氧化碳分压(PCO_2)明显低于对照组,p H高于对照组,差异有统计学意义(P<0.05)。观察组新生儿脐静脉血p H、PO_2、HCO_3~-、PCO_2及HCT与对照组新生儿比较差异无统计学意义(P>0.05);新生儿窒息发生率、死亡率均明显低于对照组,差异有统计学意义(P<0.05)。结论重度妊娠期高血压疾病合并胎儿生长受限产妇实施剖宫产可降低血压、减少并发症,使胎儿脱离缺氧环境,降低不良后果,确保母婴安全。
Objective To investigate the effect of transvaginal delivery and cesarean delivery on severe pregnancy-induced hypertensive disorders with limited fetal growth. Methods From March 2012 to February 2016, 114 pregnant women with severe gestational hypertension who were admitted to the 174 Hospital of PLA with single fetus with fetal growth restriction were selected as the study subjects and 53 cases of vaginal delivery were selected as the control group , 61 cases of cesarean delivery of maternal observation group. The SBP, DBP, pregnancy outcome, neonatal arterial and venous blood gas indexes and body weight, asphyxia and mortality were observed. Results The SBP and DBP in the observation group were significantly lower than those in the control group (P <0.01). The amount of bleeding and complications at 2 h postpartum were significantly lower than those in the control group (P < 0.05). Umbilical artery blood, bicarbonate (HCO 3 -) and hematocrit (HCT) in observation group had no significant difference compared with those in control group (P> 0.05). However, oxygen partial pressure (PO_2), carbon dioxide Pressure (PCO_2) was significantly lower than the control group, p H higher than the control group, the difference was statistically significant (P <0.05). The neonatal umbilical vein blood p H, PO 2, HCO 3 -, PCO 2 and HCT in the observation group had no significant difference compared with the control group (P> 0.05). The incidence of neonatal asphyxia and mortality were significantly lower than those in the control group , The difference was statistically significant (P <0.05). Conclusion Severe gestational hypertension with fetal growth restriction maternal implementation of cesarean section can reduce blood pressure and reduce complications, the fetus from hypoxia, reduce the adverse consequences, to ensure the safety of mother and child.