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目的:探讨子痫并发轻、中、重度肝功能损害的临床特点及对母胎结局的影响。方法:回顾分析2009年1月1日至2014年12月30日广州医科大学附属第三医院收治的79例子痫且合并肝功能损害患者的临床资料,按肝功能损害程度分为轻、中、重度3组,比较各组的临床特征及对母胎结局的影响。结果:子痫并发肝损害的发病率为0.24%(79/33084)。轻、中、重度肝功能损害患者的最高收缩压及舒张压比较,差异均有统计学意义(P<0.05);轻度与中、重度组的定期产检率比较,差异有统计学意义(P<0.05),但后两组比较差异无统计学意义(P>0.05);3组的抽搐次数比较,差异无统计学意义(P>0.05)。重度并发HELLP综合征与轻度与中度组比较,差异有统计学意义(P<0.05),后两组比较差异无统计学意义(P>0.05)。3组的入住ICU时间比较,差异有统计学意义(P<0.05),但并发胎盘早剥、心功能不全、产后出血率比较差异无统计学意义(P>0.05)。3组的新生儿窒息、胎儿生长受限、早产、转新生儿重症监护室率、围产儿死亡差异比较,差异均无统计学意义(P>0.05)。结论:血压控制不良加重肝脏损害;随着肝损害程度加重,HELLP综合征发生率及转重症监护室风险明显增加,但与围产儿结局无明显相关性。
Objective: To investigate the clinical features of eclampsia complicated with mild, moderate and severe hepatic dysfunction and its effect on the outcome of the fetuses. Methods: The clinical data of 79 patients with eclampsia and liver dysfunction admitted to the Third Affiliated Hospital of Guangzhou Medical University from January 1, 2009 to December 30, 2014 were retrospectively analyzed. According to the extent of liver dysfunction, the patients were divided into mild, moderate, Severe 3 groups, comparing the clinical features of each group and the impact on the outcome of the fetus. RESULTS: The incidence of eclampsia with liver damage was 0.24% (79/33084). The highest systolic pressure and diastolic blood pressure in patients with mild, moderate and severe liver dysfunction were significantly different (P <0.05), and the difference was statistically significant between mild and moderate and severe group (P <0.05), but there was no significant difference in the latter two groups (P> 0.05). There was no significant difference in the number of convulsions in the three groups (P> 0.05). Severe complicated with HELLP syndrome and mild and moderate groups, the difference was statistically significant (P <0.05), the difference between the latter two groups was not statistically significant (P> 0.05). There were significant differences in ICU time between the three groups (P <0.05). However, there was no significant difference in the rate of postpartum hemorrhage between the two groups (P> 0.05). No significant difference was found in neonatal asphyxia, fetal growth restriction, premature birth, neonatal intensive care unit rate and perinatal mortality among the three groups (P> 0.05). Conclusion: Poor control of blood pressure aggravates liver damage. With the aggravation of liver damage, the incidence of HELLP syndrome and the risk of intensive care unit increase significantly, but there is no significant correlation with the outcome of perinatal infants.