慢性高血压并发子痫前期的母儿结局分析

doi:10.3877/cma.j.issn.2095-3259.2021.03.007

中华产科急救电子杂志 ›› 2021, Vol. 10 ›› Issue (03) : 155 -159. doi: 10.3877/cma.j.issn.2095-3259.2021.03.007

论著

慢性高血压并发子痫前期的母儿结局分析

林琳¹, 孙雯¹, 周燕媚¹, 冯娜¹, 吴长刚², 吴玉琳², 陈敦金¹, 苏春宏¹^,^†(

)

^1. 广州医科大学附属第三医院妇产科　广东省产科重大疾病重点实验室　广州重症孕产妇救治中心　510150
^2. 贵州省，毕节市妇幼保健院妇产科　551700

收稿日期:2021-04-28 出版日期:2021-08-18
通信作者: 苏春宏
基金资助:
国家自然科学基金重点项目(81830045); 国家重点研发计划(2018YFC10029002); 广东省自然科学基金面上项目(2020A1515010273); 广州市卫健委临床高新技术建设项目(2019GX03)

Analysis of maternal and perinatal outcomes in pregnancies complicated by preeclampsia superimposed chronic hypertension and preeclampsia alone

Lin Lin¹, Wen Sun¹, Yanmei Zhou¹, Na Feng¹, Changgang Wu², Yulin Wu², Dunjin Chen¹, Chunhong Su¹^,^†()

^1. The Obstetrics and Gynecology Department of The Third Affiliated Hospital of Guangzhou Medical University, The Key Laboratory of Obstetric Diseases of Guangdong Province, Guangzhou Medical Center for Critical Pregnant Women, Guangzhou 510150, China
^2. The Obstetrics and Gynecology Department of Bijie Maternal and Child Health Hospital, Guizhou 551700, China

Received:2021-04-28 Published:2021-08-18
Corresponding author: Chunhong Su

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引用本文：

林琳, 孙雯, 周燕媚, 冯娜, 吴长刚, 吴玉琳, 陈敦金, 苏春宏. 慢性高血压并发子痫前期的母儿结局分析[J/OL]. 中华产科急救电子杂志, 2021, 10(03): 155-159.

Lin Lin, Wen Sun, Yanmei Zhou, Na Feng, Changgang Wu, Yulin Wu, Dunjin Chen, Chunhong Su. Analysis of maternal and perinatal outcomes in pregnancies complicated by preeclampsia superimposed chronic hypertension and preeclampsia alone[J/OL]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2021, 10(03): 155-159.

目的

了解慢性高血压并发子痫前期与非慢性高血压并发子痫前期患者的临床特征和母儿结局。

方法

回顾分析2009年1月1日至2017年12月31日在广州医科大学附属第三医院住院分娩的妊娠≥20周的单胎妊娠诊断为子痫前期的病例资料。按是否为慢性高血压分为慢性高血压并发子痫前期组及非慢性高血压并发子痫前期组，分析两组的临床特征与母儿结局。

结果

2361例子痫前期孕妇中，慢性高血压组共75例(27.08%)，非慢性高血压组2286例(72.92%)。慢性高血压并发子痫前期较非慢性高血压的子痫前期组孕妇，其年龄更大，高龄及经产妇更多，疤痕子宫、入院类型为门诊、产前检查(简称"产检")情况为不规律或无产检、转诊重症监护病房、早产、流产、死胎发生率更高，分娩孕周更小，新生儿体重更低，差异均有统计学意义(P均<0.05)。

结论

慢性高血压并发子痫前期孕妇相比非慢性高血压的子痫前期孕妇年龄更大，母儿不良结局风险增加。因此应当重视慢性高血压孕妇，加强高危妊娠管理，早期规范诊治，以期降低母儿不良结局。

关键词: 子痫前期, 妊娠结局, 高血压

Objective

To study the clinical characteristics and maternal and perinatal outcomes of single pregnancy with preeclampsia superimposed chronic hypertension and non-chronic hypertension in single pregnancy.

Methods

A retrospective analysis was performed on the singleton pregnancies with gestation≥20 weeks diagnosed as preeclampsia, who were admitted to The Third Affiliated Hospital of Guangzhou Medical University during 1 January 2009 and 31 December 2017.All the eligible patients were divided into preeclampsia superimposed chronic hypertension group and preeclampsia with non-chronic hypertension group.The clinical characteristics and maternal and perinatal outcomes of the two groups were analyzed.

Results

Among 2361 pregnant women with preeclamps, there were 75 cases (27.08%) in the chronic hypertension group and 2286 cases (72.92%) in the non-chronic hypertension group. The mean age of pregnant women in the preeclampsia superimposed chronic hypertension group was significantly higher than that in the non-chronic hypertension group. In the preeclampsia superimposed chronic hypertension group, the incidence of advanced maternal age women, multiparas, scarred uterus, admission to hospital were outpatient, unregular or no prenatal care, maternal referral to ICU, preterm labor, abortion, and stillbirth were higher. The gestational age at delivery and neonatal weight were both lower than that in preeclampsia superimposed chronic hypertension group, with statistically significant differences (all P<0.05).

Conclusions

The mean age of pregnant women in the preeclampsia superimposed chronic hypertension group was significantly higher than that in the preeclampsia group, with the increasing risk of maternal and neonatal adverse outcomes. Therefore, attentions should be paid to pregnant women with chronic hypertension. To reduce the adverse outcomes of maternal and perinatal, management of high-risk pregnancy should be strengthened, and early diagnosis and treatment should be standardized.

Key words: Preeclampsia, Pregnancy outcomes, Hypertension

表1 两组的一般人口学资料

组别	例数	年龄(岁，±s)	年龄[例数(%)]			初产妇[例数(%)]	疤痕子宫[例数(%)]
组别	例数	年龄(岁，±s)	<18岁	18~34岁	≥35岁	初产妇[例数(%)]	疤痕子宫[例数(%)]
慢性高血压组	75	33.96±5.04	0(0.0)	37(49.33)	38(50.67)	27(36.00)	24(32.00)
对照组	2286	31.23±5.44	5(0.22)	1621(70.91)	660(28.87)	1290(56.43)	489(21.39)
统计值		t＝-4.292		-		χ²＝12.289	χ²＝4.806
P值		0.000		0.000^a		0.000	0.028
组别	例数	入院类型[例数(%)]			产检情况[例数(%)]
组别	例数	门诊	急诊	转诊	规律	不规律	无
慢性高血压组	75	29(53.85)	9(43.33)	37(2.82)	18(24.00)	45(60.00)	12(16.00)
对照组	2286	927(44.58)	551(49.40)	808(6.02)	781(39.63)	1296(51.71)	209(8.66)
统计值		χ²＝8.518			χ²＝6.005
P值		0.014			0.049

表1 两组的一般人口学资料

组别	例数	年龄(岁，±s)	年龄[例数(%)]			初产妇[例数(%)]	疤痕子宫[例数(%)]
组别	例数	年龄(岁，±s)	<18岁	18~34岁	≥35岁	初产妇[例数(%)]	疤痕子宫[例数(%)]
慢性高血压组	75	33.96±5.04	0(0.0)	37(49.33)	38(50.67)	27(36.00)	24(32.00)
对照组	2286	31.23±5.44	5(0.22)	1621(70.91)	660(28.87)	1290(56.43)	489(21.39)
统计值		t＝-4.292		-		χ²＝12.289	χ²＝4.806
P值		0.000		0.000^a		0.000	0.028
组别	例数	入院类型[例数(%)]			产检情况[例数(%)]
组别	例数	门诊	急诊	转诊	规律	不规律	无
慢性高血压组	75	29(53.85)	9(43.33)	37(2.82)	18(24.00)	45(60.00)	12(16.00)
对照组	2286	927(44.58)	551(49.40)	808(6.02)	781(39.63)	1296(51.71)	209(8.66)
统计值		χ²＝8.518			χ²＝6.005
P值		0.014			0.049

表2 两组围产儿结局比较

组别	例数	新生儿出生体重(g，±s)	早产^a[例(%)]	流产^b[例(%)]	死胎^c[例(%)]
慢性高血压组	75	1709.55±933.58	50(66.67)	13(17.33)	20(26.67)
对照组	2286	2069.57±983.77	1261(55.16)	196(8.57)	288(12.60)
统计值		t＝3.103	χ²＝3.892	χ²＝6.905	χ²＝1.338
P值		0.002	0.049	0.009	0.000

表2 两组围产儿结局比较

组别	例数	新生儿出生体重(g，±s)	早产^a[例(%)]	流产^b[例(%)]	死胎^c[例(%)]
慢性高血压组	75	1709.55±933.58	50(66.67)	13(17.33)	20(26.67)
对照组	2286	2069.57±983.77	1261(55.16)	196(8.57)	288(12.60)
统计值		t＝3.103	χ²＝3.892	χ²＝6.905	χ²＝1.338
P值		0.002	0.049	0.009	0.000

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Analysis of maternal and perinatal outcomes in pregnancies complicated by preeclampsia superimposed chronic hypertension and preeclampsia alone

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Analysis of maternal and perinatal outcomes in pregnancies complicated by preeclampsia superimposed chronic hypertension and preeclampsia alone