本文關(guān)鍵詞： 重度子癇前期 妊娠結(jié)局 產(chǎn)兒生長發(fā)育 母親長期預(yù)后　出處：《鄭州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：背景與目的 妊娠期高血壓疾病（hypertensive disorders complicating pregnancy）是妊娠與血壓升高并存的一組疾病，發(fā)病率約5%～8%，引起的孕產(chǎn)婦死亡約占妊娠相關(guān)死亡總數(shù)的10%～16%。該組疾病嚴(yán)重影響母嬰健康，是孕產(chǎn)婦及圍產(chǎn)兒病死率升高的主要原因，包括妊娠期高血壓、子癇前期、子癇，以及慢性高血壓并發(fā)子癇前期、慢性高血壓合并妊娠。子癇前期（preeclampsia）指懷孕前血壓正常的孕婦于妊娠20周后出現(xiàn)高血壓、蛋白尿，在妊娠期高血壓疾病中很常見，且是妊娠特發(fā)，可伴有心、腦、腎、肝等臟器功能損害，是導(dǎo)致孕產(chǎn)婦及圍生兒患病率和死亡率升高的主要原因。 查閱相關(guān)資料可以得知，近年來，很多醫(yī)務(wù)工作者研究的重點(diǎn)聚焦于重度子癇前期（severe preeclampsia，sPE）的病因、發(fā)病機(jī)制等情況，但對于重度子癇前期患者較長期的預(yù)后情況及其子女的生長發(fā)育情況的跟蹤調(diào)查在國內(nèi)卻鮮有報道，國外雖有研究，但因人種、地域等差異，可能與我國情況不完全相同，我國仍需我們自己民族的研究資料。 本研究的目的如下： 1.比較正常孕產(chǎn)婦、早發(fā)型重度子癇前期（發(fā)病孕周≤34周，early onset severepreeclampsia,EOSP）及晚發(fā)型重度子癇前期（發(fā)病孕周＞34周，late onset severepreeclampsia，LOSP）患者及其所生新生兒的情況，探討早發(fā)型及晚發(fā)型重度子癇前期患者所生嬰兒結(jié)局與正常足月兒之間的差異。 2.比較我國正常學(xué)齡前兒童、早發(fā)型重度子癇前期及晚發(fā)型重度子癇前期患者所生子女（≤5歲）的生長發(fā)育情況，旨在了解三者之間的生長發(fā)育差異。 3.了解早發(fā)型重度子癇前期及晚發(fā)型重度子癇前期患者產(chǎn)后12周身體恢復(fù)情況，及此病對于患者的長期影響，并做一比較。 通過以上三方面數(shù)據(jù)的收集及比較，指導(dǎo)臨床醫(yī)生對于不同發(fā)病孕周的重度子癇前期患者進(jìn)行積極有效的救治，并提醒相關(guān)科室醫(yī)生要關(guān)注重度子癇前期患者母兒日后生存健康問題，以期對于相關(guān)疾病做到一級預(yù)防。資料與方法 收集2008年3月—2012年12月期間鄭州大學(xué)第二附屬醫(yī)院產(chǎn)科收治的符合重度子癇前期診斷標(biāo)準(zhǔn)的104例單胎患者及其子女的資料，按重度子癇前期發(fā)病時間的不同，分為：早發(fā)型重度子癇前期（發(fā)病孕周≤34周），共47例，及晚發(fā)型重度子癇前期（發(fā)病孕周＞34周），共57例。并隨機(jī)抽取同時期31例正常單胎孕產(chǎn)婦的臨床資料，以及2009年9月衛(wèi)生部婦幼保健與社區(qū)衛(wèi)生司公布的《中國7歲以下兒童生長發(fā)育參照標(biāo)準(zhǔn)》作為對比。根據(jù)重度子癇前期患者入院時提供的聯(lián)系方式，通過電話確認(rèn)其是否愿意接受回訪調(diào)查，征得同意后，采用電話回訪的方式收集數(shù)據(jù)。其中，早發(fā)型重度子癇前期共收集到數(shù)據(jù)34人（回訪率72.34%），晚發(fā)型重度子癇前期共收集到數(shù)據(jù)46人（回訪率80.70%）。 本調(diào)查研究共包括3部分：第一部分通過收集我院病案室已有的資料，比較31例正常產(chǎn)婦、47例早發(fā)型重度子癇前期及57例晚發(fā)型重度子癇前期患者所生新生兒的身長、體重，比較三組之間的差異；第二部分通過電話回訪，收集到早發(fā)型重度子癇前期患者所生子女1～5歲數(shù)據(jù)分別6、8、5、0、6例，及晚發(fā)型重度子癇前期患者所生子女1～5歲數(shù)據(jù)分別14、3、8、10、11例，與2009年9月衛(wèi)生部婦幼保健與社區(qū)衛(wèi)生司公布的《中國7歲以下兒童生長發(fā)育參照標(biāo)準(zhǔn)》作為對照，比較三者之間的差異；第三部分通過電話回訪，收集重度子癇前期患者血壓等指標(biāo)，了解其產(chǎn)后恢復(fù)情況，比較34例早發(fā)型及46例晚發(fā)型重度子癇前期患者遠(yuǎn)期結(jié)局。 結(jié)果 1.正常足月兒、早發(fā)型及晚發(fā)型重度子癇前期新生兒出生情況 三組嬰兒中，早發(fā)型患者所生嬰兒(＜3個月)死亡率達(dá)到23.4%，晚發(fā)型及正常者所生嬰兒未見死亡情況。正常組嬰兒出生時身長、體重等指標(biāo)與早發(fā)型組及晚發(fā)型組比較，差異有統(tǒng)計學(xué)意義（P＜0.05）；晚發(fā)型組嬰兒出生時身長、體重與早發(fā)型組比較，差異有統(tǒng)計學(xué)意義（P＜0.05）。 2.早發(fā)型及晚發(fā)型重度子癇前期患者所生子女（≤5歲）的生長發(fā)育情況 早發(fā)型重度子癇前期患者所生的低出生體重兒（80.00%）及晚發(fā)型重度子癇前期患者所生的低出生體重兒(80.00%)于出生后1月～1周歲生長發(fā)育指標(biāo)通過趕上生長達(dá)到國家標(biāo)準(zhǔn)。早發(fā)型、晚發(fā)型與正常兒童1～5歲身高（身長）、體重相比，除晚發(fā)型組與正常組5歲身高差異有統(tǒng)計學(xué)意義外（P＜0.05），余早發(fā)型組、晚發(fā)型組各年齡段身高（身長）、體重與正常組相比，差異均無統(tǒng)計學(xué)意義（P＞0.05）。 3.早發(fā)型及晚發(fā)型重度子癇前期患者的產(chǎn)后身體恢復(fù)情況 早發(fā)型組中產(chǎn)后12周血壓未恢復(fù)正常者12人(35.29%)，晚發(fā)型組中產(chǎn)后12周血壓未恢復(fù)正常者7人(15.22%)，，早發(fā)型組及晚發(fā)型組產(chǎn)后12周血壓恢復(fù)情況比較，差異有統(tǒng)計學(xué)意義（P＜0.05）。 結(jié)論 1.早發(fā)型重度子癇前期患者所生嬰兒死亡率較高，晚發(fā)型重度子癇前期患者子女出生結(jié)局好于早發(fā)型重度子癇前期患者子女，但差于正常足月兒。 2.對于重度子癇前期患者所生的低出生體重兒，無論早發(fā)型或晚發(fā)型，在出生后1個月～1周歲內(nèi)多數(shù)生長發(fā)育指標(biāo)能達(dá)到正常標(biāo)準(zhǔn)。 3.重度子癇前期患者子女在粗動作與平衡發(fā)展方面顯示出不足，其中，早發(fā)型患者子女發(fā)生率更高。 4.早發(fā)型、晚發(fā)型重度子癇前期患者子女及我國正常兒童三者1～5周歲身體生長發(fā)育、智力等情況無明顯差異。 5.早發(fā)型重度子癇前期患者較晚發(fā)型重度子癇前期患者產(chǎn)后更容易發(fā)生慢性高血壓疾病。
[Abstract]:Background and purpose
Pregnancy induced hypertension (hypertensive disorders complicating pregnancy) is a group of diseases of pregnancy coexisting with elevated blood pressure, the incidence rate of about 5% to 8%, accounting for about 10% of the total number of deaths from pregnancy related deaths caused by maternal 16%. this disease seriously affecting maternal and child health, is a major cause of maternal and perinatal mortality, including pregnancy hypertension, preeclampsia, eclampsia, and chronic hypertension and pre eclampsia, chronic hypertension in pregnancy. Pre eclampsia (preeclampsia) refers to the normal blood pressure in pregnant women before pregnancy 20 weeks after the onset of hypertension, proteinuria, is common in hypertensive disorders in pregnancy, and pregnancy is idiopathic, with heart, brain, kidney, liver and other organ damage, is the leading cause of maternal and perinatal morbidity and mortality rate increased the main reason.
Access to relevant information that, in recent years, many medical workers are the focus of the study focused on severe preeclampsia (severe preeclampsia, sPE) the etiology, pathogenesis and other conditions, but for the follow-up survey of patients with severe preeclampsia than the long-term prognosis of children and the growth and development situation at home and abroad are rarely reported, although the study but, because of race, regional differences, possibly with the situation in our country is not exactly the same, it is necessary for China to study our own nation.
The purpose of this study is as follows:
1. normal pregnant women with early onset severe preeclampsia (gestational age less than 34 weeks, early onset severepreeclampsia, EOSP) and late onset severe preeclampsia (gestational weeks, 34 weeks, late onset severepreeclampsia, LOSP) patients and their neonates situation, explore the differences between the outcome of baby born in early and late onset in patients with severe preeclampsia and normal full-term infants.
2. comparison of China's normal preschool children, the children of early-onset severe preeclampsia and late onset severe preeclampsia (less than 5) growth and development, in order to understand the growth and development of the difference between the three.
3. understand the early recovery, severe preeclampsia and late-onset severe preeclampsia, 12 weeks postpartum physical recovery, and the long-term impact of this disease on patients, and make a comparison.
Through the collection and comparison of the above three aspects of data, guide clinicians to active and effective remedy for different gestational weeks with severe preeclampsia, health problems and related departments to remind doctors to survive on patients with severe preeclampsia maternal days after, in order to achieve the primary prevention of diseases related to materials and methods.
From March 2008 to December 2012 in the Second Affiliated Hospital of Zhengzhou University obstetrics treated with severe preeclampsia diagnosis of 104 cases of singleton patients and their children, according to the different time of onset of severe preeclampsia, divided into: early onset severe preeclampsia (gestational age less than 34 weeks), a total of 47 cases, and late onset severe preeclampsia early (gestational age > 34 weeks), a total of 57 cases. And the clinical data were randomly selected from the same period 31 cases of normal singleton pregnant women, the development of reference standard > as a comparative growth and in September 2009 the Ministry of health of maternal and child health care and community Health Department announced the "China children under the age of 7. According to the admission of patients with severe preeclampsia contact by telephone to confirm whether it is willing to accept a return visit survey, consent, data collected by telephone interviews. Among them, the early onset of severe preeclampsia were collected data 3 4 people (return rate of 72.34%), late onset severe preeclampsia collected data of 46 people (return rate of 80.70%).
This study includes 3 parts: through the collection of the Department of medical records for the first part, 31 cases of normal pregnant women, infants born in 47 cases of early onset severe preeclampsia and 57 cases of late onset severe preeclampsia patients with body height, body weight, compared the differences between the three groups; the second part through telephone interviews, collecting to the early onset of severe preeclampsia patients born 1~5 year old data were 6,8,5,0,6 cases, and late-onset preeclampsia children born 1~5 year old data were 14,3,8,10,11 cases, the development of reference standard > as control and growth announced in September 2009 the Ministry of health of maternal and child health care and community health department "Chinese children under 7 years of age, the difference between the three the third part; through telephone interviews, collecting the blood pressure of patients with severe preeclampsia, the postpartum recovery, 34 cases of early onset and late onset severe in 46 cases Long term outcome of patients with preeclampsia.
Result
1. normal foot months, early onset and late onset severe preeclampsia newborns
Three groups of infants, babies born early onset (< 3 months) the mortality rate reached 23.4%, the situation of late-onset and normal persons born baby no death. The normal group baby birth length, compared with early onset and late onset group weight index, the difference was statistically significant (P < 0.05); late hair infants birth length, compared with early onset group weight, the difference was statistically significant (P < 0.05).
2. children born in early and late onset severe preeclampsia (less than 5) the growth and development situation
Low birth weight infants with early onset severe preeclampsia (born 80%) low birth weight infants and late-onset preeclampsia (born 80%) was born after January to 1 years of growth and development indexes by catch growth reached the national standard. The early onset and late onset, normal children 1~5 years of age and height (length in addition, weight) compared with late onset group and the normal group of 5 years old height statistically significant difference (P < 0.05), more than the early onset group and late onset group at each age height (length), body weight compared with the normal group, there were no significant differences (P > 0.05).
Postpartum recovery in patients with 3. early onset and late onset severe preeclampsia
In the early onset group, 12 (35.29%) did not return to normal blood pressure at 12 weeks postpartum, and 7 (15.22%) did not return to normal blood pressure in the late-onset group at 12 weeks postpartum. There was a significant difference in blood pressure recovery between the early onset group and the late onset group at 12 weeks postpartum (P < 0.05).
conclusion
1. the early-onset severe preeclampsia has a higher infant mortality rate, and the late onset severe preeclampsia children's birth outcomes are better than those of the early onset severe preeclampsia children, but worse than the normal term infants.
2., for the low birth weight infants born in severe preeclampsia, no matter early or late onset, most of the growth and development indicators can reach the normal standard within 1 months to 1 years after birth.
3. the children of severe preeclampsia have a deficiency in the development of rough and balanced development, of which the incidence of children in early onset patients is higher.
4. early hair style, late onset severe preeclampsia and three normal children in China were 1~5 weeks old, and there was no significant difference in intelligence.
5. early onset severe preeclampsia patients with late onset severe preeclampsia are more likely to have chronic hypertension after the postpartum period.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.244

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