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目的探讨妊娠合并慢性高血压患者于不同孕周口服低剂量阿司匹林在预防子痫前期(preeclampsia,PE)发生的作用。方法妊娠合并慢性高血压患者150例,12~16孕周开始口服阿司匹林(75mg/d)52例为观察1组,≥孕16周开始口服阿司匹林(75mg/d)48例为观察2组,孕期未口服阿司匹林50例为对照组。比较3组孕期并发症发生情况及妊娠结局。结果 3组均无死亡及心、脑血管意外发生;观察1组PE发生率(57.7%)低于观察2组(79.2%)和对照组(92.0%)(P<0.05),发病孕周[(33.3±3.2)周]、分娩孕周[(37.1±3.4)周]较观察2组[(28.8±2.7)、(32.5±4.2)周]及对照组[(27.2±2.5)、(31.3±4.0)周]晚(P<0.05),重度PE(23.1%)、胎盘早剥(0)、肺水肿(5.8%)、低蛋白血症(1.9%)、致死性引产(1.9%)及胎儿生长受限发生率(15.4%)均低于观察2组(45.8%、10.4%、31.3%、20.8%、14.6%、37.5%)和对照组(62.0%、14.0%、36.0%、24.0%、20.0%、46.0%)(P<0.05),观察2组和对照组比较差异均无统计学意义(P>0.05);3组轻度PE、子痫、HELLP综合征、视网膜剥脱、产后出血发生率及胎死宫内、新生儿窒息及新生儿病死率比较差异均无统计学意义(P>0.05)。结论妊娠合并慢性高血压患者于12~16孕周开始口服低剂量阿司匹林可有效降低PE尤其是重度PE发生率,推迟PE发病孕周,延长分娩孕周,降低胎盘早剥、肺水肿、低蛋白血症、致死性引产及胎儿生长受限发生率,且不增加产后出血率。
Objective To investigate the effect of oral administration of low-dose aspirin at different gestational weeks on the prevention of preeclampsia (PE) in pregnant women with chronic hypertension. Methods 150 cases of pregnancy complicated with chronic hypertension, 12 to 16 gestational weeks began aspirin (75mg / d) 52 cases were observed in group 1, ≥ 16 weeks of pregnancy started aspirin (75mg / d) 48 cases were observed in 2 groups during pregnancy 50 cases without oral aspirin as control group. Comparing the incidence of pregnancy complications and pregnancy outcomes in the three groups. Results No death and cardiovascular or cerebrovascular accident occurred in the three groups. The incidence of PE in group 1 (57.7%) was lower than that in group 2 (79.2%) and control group (92.0%) (P <0.05) (33.3 ± 3.2) weeks, gestational weeks [(37.1 ± 3.4) weeks) than those in the control group [(28.8 ± 2.7), (32.5 ± 4.2) weeks] and the control group [(27.2 ± 2.5), (31.3 ± (P <0.05), severe PE (23.1%), placental abruption (0), pulmonary edema (5.8%), hypoproteinemia (1.9%), fatal induced labor (1.9%) and fetus The incidence of growth restriction (15.4%) was lower than that of the control group (62.0%, 14.0%, 36.0%, 24.0%, respectively) in the observation group 2 (45.8%, 10.4%, 31.3%, 20.8%, 14.6%, 37.5% 20.0% and 46.0%, respectively) (P <0.05). There was no significant difference between the two groups and the control group (P> 0.05); mild PE, eclampsia, HELLP syndrome, retinal detachment and postpartum hemorrhage Rates and fetal death in the womb, neonatal asphyxia and neonatal mortality rates were no significant difference (P> 0.05). Conclusions Low-dose aspirin can reduce the incidence of PE, especially severe PE, in gestational hypertension patients with gestational hypertension from 12 to 16 gestational weeks, delay gestational age of PE, prolong the gestational age of childbirth, reduce placental abruption, pulmonary edema, low protein Hemophilia, fatal induction of labor and the incidence of fetal growth restriction, and does not increase the rate of postpartum hemorrhage.