發(fā)布時間：2018-06-30 10:11

  本文選題：妊娠期高血壓疾病 + 相關(guān)因素　； 參考：《大連醫(yī)科大學》2014年碩士論文

【摘要】：目的：了解妊娠期高血壓疾病發(fā)生的流行病學相關(guān)因素以及該病對圍生兒結(jié)局的不良影響，為該病的病因研究以及防治提供臨床依據(jù)。 方法：采用大樣本回顧性分析的流行病學方法，選取2012年01月-2013年12月期間于北京軍區(qū)總醫(yī)院婦產(chǎn)科住院分娩妊娠期高血壓疾病患者292人作為觀察對象，選取同期住院分娩的正常孕婦作為對照。采集兩組孕婦的相關(guān)參數(shù)：1、一般情況：產(chǎn)婦的年齡、分娩時孕齡、孕次、產(chǎn)次、胎兒性別、高血壓家族史等；2、孕期并發(fā)癥發(fā)生情況，如視網(wǎng)膜病變、妊娠期糖尿病、急性肺損傷、急性腎功不全、胎盤早剝、前置胎盤、妊高癥性心臟病、腦血管意外、HELLP綜合征等；3、分娩結(jié)局：分娩孕周、分娩方式、產(chǎn)后出血、產(chǎn)后貧血等；4、圍生兒結(jié)局：出生低體重、胎兒窘迫、新生兒窒息、圍生兒死亡等。采用獨立樣本t檢驗、χ2檢驗等研究與妊娠期高血壓疾病發(fā)生相關(guān)的危險因素，以及該病對妊娠結(jié)局和圍生兒結(jié)局的影響。 結(jié)果：1、與妊娠期高血壓疾病發(fā)生相關(guān)的危險因素分析：（1）觀察組和對照組孕婦平均年齡分別為（30.56±4.35）歲和(25.0±3.13)歲，，前者顯著大于后者（P＜0.05）；兩組孕婦年齡大于35歲的比例分別為15.41%和3.42%，差異也有統(tǒng)計學差異（P＜0.05）；（2）觀察組和對照組孕婦孕前體重指數(shù)分別為(27.31±1.89)和(23.45±2.11)，兩組比較，前者顯著大于后者（P＜0.05）；（3）觀察組和對照組孕婦有高血壓家族史的比例分別為26.03%和5.82%，兩組比較，前者顯著高于后者（P＜0.05）；（4）觀察組孕婦圍生期視網(wǎng)膜病變、妊娠期糖尿病、急性肺損傷、急性腎功不全、胎盤早剝、前置胎盤的發(fā)生率分別為10.62%、7.19%、4.11%、3.42%、2.74%和2.05%，對照組孕婦圍生期上述病變發(fā)生率均為0，兩組比較，差異均有統(tǒng)計學意義（P＜0.05）。2、妊娠期高血壓疾病對分娩結(jié)局的影響：觀察組孕婦早產(chǎn)、足月產(chǎn)、剖宮產(chǎn)、陰道分娩、產(chǎn)后出血、產(chǎn)后貧血的發(fā)生率分別為42.81%、57.19%、90.41%、9.59%、6.85%和16.44%，對照組孕婦上述發(fā)生率分別為14.04%、85.96%、43.49%、56.51%、0.34%和5.14%。兩組比較，差異均有統(tǒng)計學意義（P＜0.05）。3、妊娠期高血壓疾病對圍生兒結(jié)局的影響：觀察組新生兒低體重兒、胎兒窘迫、新生兒窒息和圍生兒死亡發(fā)生率分別為10.96%、5.14%、5.82%和1.37%，對照組孕婦上述發(fā)生率分別為2.74%、1.37%、1.03%和0.00%，兩組比較，差異均有統(tǒng)計學意義（P＜0.05）。 結(jié)論： 1、高齡（大于35歲）可能是妊娠期高血壓疾病發(fā)病的危險因素； 2、孕前肥胖可能是妊娠期高血壓疾病發(fā)病的危險因素； 3、高血壓家族史可能是妊娠期高血壓疾病發(fā)病的危險因素； 4、某些孕期和圍生期并發(fā)癥可能與妊娠期高血壓疾病互為因果，互相加重其病理過程； 5、妊娠期高血壓疾病可導致不良分娩結(jié)局和不良圍生兒結(jié)局，對其分娩時機、分娩方式的把握有利于改善圍生期預(yù)后。
[Abstract]:Objective: to investigate the related epidemiological factors of hypertensive disorder complicating pregnancy and the adverse effects of the disease on perinatal outcome, so as to provide the clinical basis for the study of the etiology and prevention of the disease. Methods: a total of 292 pregnant women with hypertension complicating pregnancy were selected from January 2012 to December 2013 in Beijing military region General Hospital from January 2012 to December 2013. Normal pregnant women who were given birth in hospital at the same time were selected as control. The related parameters of two groups of pregnant women were collected: age of parturient, gestational age at parturition, pregnancy, delivery, fetal sex, family history of hypertension, and complications during pregnancy, such as retinopathy, gestational diabetes mellitus, and so on. Acute lung injury, acute renal insufficiency, placental abruption, placenta previa, PIH heart disease, cerebrovascular accident and HELLP syndrome, etc. 4, perinatal outcome: low birth weight, fetal distress, neonatal asphyxia, perinatal death and so on. Independent sample t test and 蠂 2 test were used to study the risk factors associated with hypertensive disorder complicating pregnancy and the influence of the disease on pregnancy outcome and perinatal outcome. Results: (1) the mean age of pregnant women in the observation group and the control group were (30.56 鹵4.35) years and (25.0 鹵3.13) years, respectively, which were significantly higher than the latter (P < 0.05). The percentage of pregnant women over 35 years old in the two groups was 15.41% and 3.42, respectively, and the difference was also statistically significant (P < 0. 05). The body mass index of pregnant women in the observation group and the control group were (27. 31 鹵1. 89) and (23. 45 鹵2. 11), respectively. The former group was significantly higher than the latter group (P < 0. 05). (3) the proportion of pregnant women with family history of hypertension was 26.03% in the observation group and 5.82% in the control group. The former group was significantly higher than the latter group (P < 0. 05); (4). In the observation group, the incidence of perinatal retinopathy, gestational diabetes mellitus and acute lung injury were significantly higher than those in the control group (P < 0. 05). The incidence of acute renal insufficiency, placental abruption and placenta previa were 10.627.19% and 2.05%, respectively. The difference was statistically significant (P < 0.05). 2. The effect of hypertensive disorder complicating pregnancy on the outcome of delivery: premature delivery, term delivery, cesarean section, vaginal delivery and postpartum hemorrhage in the observation group. The incidence of postpartum anemia was 42.81% and 9.595.85% and 16.4445%, respectively. The above rates of pregnant women in the control group were 14.0455.96and 43.495.490.34% and 5.14%, respectively.The results showed that the incidence of postpartum anemia was 0.34% and 16.44%, respectively, and that of the pregnant women in the control group was 0.34% and 5.14%, respectively. There were significant differences between the two groups (P < 0.05). 3. The effect of hypertensive disorder complicating pregnancy on perinatal outcome: low birth weight newborn, fetal distress, The incidence of neonatal asphyxia and perinatal death was 10.96 5.14% and 1.37%, respectively, while that of the control group was 1.37% and 1.73%, respectively. The difference between the two groups was statistically significant (P < 0.05). Conclusion: (1) Old age (older than 35 years) may be the risk factor of hypertensive disorder complicating pregnancy, 2, obesity before pregnancy may be the risk factor of hypertensive disorder complicating pregnancy. (3) the family history of hypertension may be the risk factor of hypertensive disorder complicating pregnancy, 4, some complications during pregnancy and perinatal period may be causality with hypertensive disorder complicating pregnancy, and the pathological process of hypertension complicating pregnancy may be aggravated by each other. 5. Hypertensive disorder complicating pregnancy can lead to bad delivery outcome and bad perinatal outcome. It is helpful to improve the perinatal prognosis by grasping the delivery time and delivery mode.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R714.246

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