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中华产科急救电子杂志

中华产科急救电子杂志 ›› 2021, Vol. 10 ›› Issue (02) : 105 -109. doi: 10.3877/cma.j.issn.2095-3259.2021.02.009

论著

子痫前期合并阻塞性睡眠呼吸暂停低通气综合征的临床分析
黄耀光1, 汤雯婷2, 李仲均1, 傅明1, 何锦添1, 罗嘉龙1, 黄素然1, 萧丽娟1,†()   
  1. 1. 523000　广东省，东莞市人民医院耳鼻喉科
    2. 523000　广东省，东莞市人民医院妇产科
  • 收稿日期:2020-08-21 出版日期:2021-05-18
  • 通信作者: 萧丽娟
  • 基金资助:
    广东省自然科学基金面上项目(2020A1515010597); 东莞市人民医院科研发展基金计划项目(K201911)

Clinical analysis of preeclampsia with obstructive sleep apnea hypopnea syndrome

Yaoguang Huang1, Wenting Tang2, Zhongjun Li1, Ming Fu1, Jintian He1, Jialong Luo1, Suran Huang1, Lijuan Xiao1,†()   

  1. 1. Department of Obstetrics and Gynecology; Department of Otolaryngology Head and Neck Surgery, Affiliated Dongguan People′s Hospital, Southern Medical University, Dongguan 523000, China
  • Received:2020-08-21 Published:2021-05-18
  • Corresponding author: Lijuan Xiao
  • About author:
    Huang Yaoguang and Tang Wenting are the first authors who contributed equally to the article.
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黄耀光, 汤雯婷, 李仲均, 傅明, 何锦添, 罗嘉龙, 黄素然, 萧丽娟. 子痫前期合并阻塞性睡眠呼吸暂停低通气综合征的临床分析[J/OL]. 中华产科急救电子杂志, 2021, 10(02): 105-109.

Yaoguang Huang, Wenting Tang, Zhongjun Li, Ming Fu, Jintian He, Jialong Luo, Suran Huang, Lijuan Xiao. Clinical analysis of preeclampsia with obstructive sleep apnea hypopnea syndrome[J/OL]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2021, 10(02): 105-109.

目的

探讨子痫前期合并阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome，OSAHS)的临床特征及其母婴近期结局。

方法

选择2018年6月至2019年6月在东莞市人民医院收治住院的子痫前期孕妇，共有68例孕妇纳入研究，经多导睡眠监测确诊为OSAHS设为OSAHS组32例，未符合诊断标准者为非OSAHS组36例，并收集两组的临床资料进行分析。

结果

两组孕妇年龄、重度子痫发生率、发病孕周差异均无统计学意义(P>0.05)。OSAHS组孕妇未规律产检者多见(P<0.05)。OSAHS组ESS评分(9.25±3.51)分，睡眠呼吸暂停低通气指数(10.56±3.40)次/h，高于非OSAHS组[(6.89±3.11)分、(3.17±0.94)次/h](P<0.01)；夜间最低血氧饱和度(85.22±3.40)%，较非OSAHS组低(93.10±2.09)%(t＝-11.661，P<0.01)。OSAHS组孕前体重指数(23.76±3.38)kg/m2、孕早期体重增加(1.62±1.03)kg、颈围(36.72±3.07)cm，分别较非OSAHS组高[(22.02±0.57)kg/m2、(0.87±0.93)kg和(35.17±2.27)cm](P<0.01)。OSAHS组孕妇早产发生率(78.13%，25/32)，高于非OSAHS组(55.56%，19/36)( χ2＝4.766，P<0.05)。OSAHS组的新生儿窒息率为(28.13%，9/32)，高于非OSAHS组(8.33%，3/36)( χ2＝4.566，P<0.05)；OSAHS组的新生儿Apgar评分较低且新生儿重症监护病房入住率较高；两组新生儿出生体重、气管插管率差异均无统计学意义(P>0.05)。

结论

对存在打鼾现象的孕妇应给予更多的关注，孕前体重指数水平过高、孕早期增重过量、颈围过长是子痫前期孕妇发生OSAHS的危险因素，及时诊断是否为OSAHS并进行必要早期干预有效促进母婴健康。

关键词: 先兆子痫, 睡眠呼吸暂停，阻塞性, 妊娠
Objective

To explore the clinical characteristics of preeclampsia with obstructive sleep apnea hypopnea syndrome(OSAHS)and the short-term outcomes of mother and newborn.

Methods

68 pregnant women with preeclampsia, who were admitted to Dongguan people′s hospital from June 2018 to June 2019, were selected. The patients were divided into two groups. 32 patients in OSAHS group, were diagnosed as OSAHS by polysomnography (PSG). 36 patients did not meet the diagnostic criteria, who were set as Non-OSAHS group. Clinical data of two groups were collected for analysis.

Results

There were no significant difference in age, incidence of severe eclampsia and gestational age between two groups (P>0.05). The number of pregnant women with irregular prenatal examination in OSAHS group was higher than in Non-OSAHS group (P<0.05). The ESS score (9.25±3.51) and AHI [(10.56±3.40) /h] were higher in OSAHS group than that in Non-OSAHS group (P<0.01). The lowest nighttime SpO2 [(85.22±3.40) %] was lower in OSAHS group than that in Non-OSAHS group (P<0.01). The pre-pregnancy BMI [(23.76±3.38) kg/m2], weight gain in early pregnancy [(1.62±1.03) kg] and neck circumference [(36.72±3.07) cm] in the OSAHS group were higher than those [(22.02±2.57)kg/m2、(0.87±0.93)kg、(35.17±2.27)cm] in the non-OSAHS group (P<0.01). The incidence of preterm delivery in OSAHS group was higher than in Non-OSAHS group (P<0.05). Neonatal asphyxia rate, Apgar score and the rate of newborn transferring to NICU in OSAHS group were significantly higher than in Non-OSAHS group (P<0.05). However, there were no significant difference in birth weight and tracheal intubation rate in two groups.

Conclusions

Pregnant women with snore should be paid more attention. High pre-pregnancy BMI, excessive weight gain in early pregnancy and excessive neck circumference are the risk factors for preeclampsia patients to have OSAHS. Timely diagnosis and effectively intervention of OSAHS may promote maternal and infant health.

Key words: Preeclampsia, Sleep apnea, obstructive, Pregnancy
表1 68例子痫前期患者的基本资料
组别 例数 重度子痫前期[例(%)] 年龄(岁，±s) 发病孕周(周，±s) 规律产检[例(%)] 大专及以上学历[例(%)] 住院治疗时间(d，±s)
OSAHS组 32 13(40.62) 32.00±5.47 29.43±4.19 21(65.63) 19(59.38) 12.06±2.64
非OSAHS组 36 10(27.78) 31.78±5.88 30.84±3.87 31(86.11) 30(83.33) 11.08±2.86
统计值   χ2＝1.249 t＝0.161 t＝-1.449 χ2＝3.951 χ2＝4.830 t＝1.460
P值   0.264 0.873 0.152 0.047 0.028 0.149
表2 68例子痫前期患者的临床症状
组别 例数 ESS评分(分，±s) STOP-BANG问卷[例(%)] 睡眠打鼾[例(%)] AHI(次/h，±s) 夜间最低SpO2(%，±s)
低危 高危
OSAHS组 32 9.25±3.51 10(31.25) 22(68.75) 32(100.00) 10.56±3.40 85.22±3.40
非OSAHS组 36 6.89±3.11 16(44.44) 20(55.56) 17(47.22) 3.17±0.94 93.10±2.09
统计值   t＝2.939 χ2＝1.249 - t＝12.531 t＝-11.661
P值   0.005 0.264 0.000* 0.000 0.000
表3 68例子痫前期患者的查体情况(±s)
组别 例数 入院收缩压(mmHg) 入院舒张压(mmHg) 孕前BMI(kg/m2) 孕早期体重增加(kg) 入院颈围(cm)
OSAHS组 32 153.09±14.63 97.25±11.72 23.76±3.38 1.62±1.03 36.72±3.07
非OSAHS组 36 152.31±14.09 95.94±11.37 22.02±2.57 0.87±0.93 35.17±2.27
t值   0.226 0.466 2.406 3.141 2.385
P值   0.822 0.643 0.019 0.003 0.020
表4 68例子痫前期患者的妊娠结局[例(%)]
组别 例数 剖宫产 早产 胎膜早破 胎盘早剥 产后出血 转入NICU
OSAHS组 32 27(84.38) 25(78.13) 4(12.50) 2(6.25) 3(9.38) 4(12.50)
非OSAHS组 36 30(83.33) 19(55.56) 6(16.67) 1(2.78) 2(5.56) 3(8.33)
χ2值   0.014 4.766 0.020 0.011 0.019 0.027
P值   0.907 0.029 0.888 0.917 0.891 0.869
表5 68例子痫前期患者的围产儿结局
组别 例数 足月低体重儿[例(%)] 早产低体重儿[例(%)] 新生儿窒息[例(%)] Apgar评分(分，±s) 气管插管[例(%)] 转入NICU[例(%)]
1 min 5 min
OSAHS组 32 5(15.63) 17(53.13) 9(28.13) 7.84±1.16 8.28±0.92 4(12.50) 24(75.00)
非OSAHS组 36 3(8.33) 15(41.67) 3(8.33) 8.69±0.71 8.78±0.54 2(5.56) 18(50.00)
统计值   χ2＝0.868 χ2＝0.893 χ2＝4.566 t＝-3.677 t＝-2.741 χ2＝0.336 χ2＝4.484
P值   0.352 0.345 0.033 0.000 0.008 0.562 0.034
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