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目的探讨妊娠期肝内胆汁淤积症(ICP)分度诊断及处理的围产结局。方法将2007年1月至2011年12月在重庆医科大学附属第一医院检查并诊断为ICP的324例患者,应用我院自订标准,根据血清总胆汁酸、胆红素和转氨酶水平分为轻度(248例)和重度ICP组(76例),并进行对应处理;选择同期正常孕妇324例为对照组,比较轻度、重度ICP组和对照组的围产结局。结果 (1)轻度、重度ICP组的早产率(11.7%、85.5%)、剖宫产率(58.9%、93.4%)和羊水粪染率(11.3%、40.8%)明显高于对照组(5.9%、38.9%、4.6%),差异均有统计学意义(P<0.05)。(2)重度ICP组患者羊水粪染和新生儿转重症监护室率分别为40.8%和22.4%,与轻度组(11.3%、5.2%)比较,差异有统计学意义(P<0.05)。(3)采用分度诊断与针对性处理后的围产儿死亡率为0.6%(2/324),与传统分度管理(2002-2006年围产儿死亡率2.6%)相比较,明显降低(P<0.01)。结论对ICP患者进行分度与处理,可改善围产儿预后。
Objective To investigate the perinatal outcome of the diagnosis and treatment of intrahepatic cholestasis of pregnancy (ICP). Methods From January 2007 to December 2011 in Chongqing First Affiliated Hospital of Chongqing Medical University, 324 patients diagnosed and diagnosed as ICP, using our hospital-based criteria, according to the total serum bile acid, bilirubin and aminotransferase levels were divided into (248 cases) and severe ICP group (76 cases). The normal pregnant women (324 cases) were selected as the control group, and the perinatal outcome was compared between mild ICP group and control group. Results (1) The rates of preterm delivery (11.7%, 85.5%), cesarean section rate (58.9%, 93.4%) and amniotic fluid meningitis rate (11.3%, 40.8%) in mild and severe ICP group were significantly higher than those in control group 5.9%, 38.9%, 4.6%), the difference was statistically significant (P <0.05). (2) The rates of meconium-stained amniotic fluid and neonatal intensive care unit in patients with severe ICP were 40.8% and 22.4%, respectively, which were significantly different from those in mild patients (11.3% and 5.2%, P <0.05). (3) Perinatal mortality after diagnosis and targeted treatment was 0.6% (2/324), which was significantly lower than the traditional index management (perinatal mortality from 2002 to 2006 2.6%) (P <0.01). Conclusion Indexing and treatment of ICP patients can improve perinatal outcome.