妊娠期高血壓疾病相關(guān)危險(xiǎn)因素及母嬰結(jié)局的臨床分析
發(fā)布時(shí)間：2019-05-18 22:36
【摘要】：目的:研究妊娠期高血壓疾病發(fā)病的相關(guān)危險(xiǎn)因素及不良妊娠結(jié)局,探討妊娠期高血壓疾病的合理治療,為臨床醫(yī)生診治該病提供臨床指導(dǎo)意義。方法:采用大樣本回顧性分析的研究方法,收集2015年1月至2016年12月就診于蘭州大學(xué)第一醫(yī)院婦產(chǎn)科,明確診斷為妊娠期高血壓疾病,同時(shí)順利分娩的孕產(chǎn)婦436例作為觀察組,另隨機(jī)選擇同一時(shí)間段在該院婦產(chǎn)科住院分娩,且孕期的各項(xiàng)臨床檢驗(yàn)指標(biāo)均正常的孕婦436例作為對(duì)照組。詳細(xì)收集兩組孕婦的一般情況、分娩結(jié)局、圍生兒結(jié)局、臨床檢驗(yàn)指標(biāo)(血常規(guī)、凝血功能)等信息。采用獨(dú)立樣本t檢驗(yàn)、χ2檢驗(yàn)及多因素非條件Logistic回歸分析的統(tǒng)計(jì)學(xué)方法進(jìn)行數(shù)據(jù)分析。結(jié)果:1.平均年齡方面,觀察組的均值大于對(duì)照組,兩組相比,差異有統(tǒng)計(jì)學(xué)意義;其中孕婦年齡≥35歲的,兩組比例分別為44.50%、36.24%,差異也有統(tǒng)計(jì)學(xué)意義;2.雙胎妊娠,兩組比例分別為13.30%、4.82%,差異有統(tǒng)計(jì)學(xué)意義;3.IVF-ET術(shù)后,觀察組的比例為16.51%,對(duì)照組為6.65%,兩組比較,差異有統(tǒng)計(jì)學(xué)意義;4.規(guī)范產(chǎn)檢,兩組比例分別為52.06%、68.35%,差異有統(tǒng)計(jì)學(xué)意義;5.文化水平(大專及以上),兩組比例分別為40.60%、56.20%,差異有統(tǒng)計(jì)學(xué)意義;6.肥胖(孕前BMI≥28kg/m2),兩組比例分別為50.23%、43.12%,差異有統(tǒng)計(jì)學(xué)意義;7.白細(xì)胞計(jì)數(shù)及其分類(淋巴細(xì)胞、中性粒細(xì)胞),疾病組平均值均大于正常妊娠組,兩兩相比,差異均有統(tǒng)計(jì)學(xué)意義;輕度子癇前期組與重度子癇前期組的白細(xì)胞計(jì)數(shù)及其分類的均值比較,差異無統(tǒng)計(jì)學(xué)意義;8.凝血功能方面,疾病組PLT、PT、APTT、TT的均值均小于正常妊娠組,FIB的平均值大于正常妊娠組,差異均有統(tǒng)計(jì)學(xué)意義;輕度子癇前期組PLT、PT、APTT、TT的均值均小于重度子癇前期組,FIB的平均值大于重度子癇前期組,差異也有統(tǒng)計(jì)學(xué)意義;9.將上述有意義的單因素納入多因素非條件Logistic回歸模型分析顯示,高齡、雙胎妊娠、試管嬰兒、孕前BMI、白細(xì)胞、中性粒細(xì)胞、PLT、PT、FIB是HDCP發(fā)病的危險(xiǎn)因素;而規(guī)范產(chǎn)檢和文化水平是HDCP的保護(hù)性因素;10.早產(chǎn)、剖宮產(chǎn)、產(chǎn)后出血的發(fā)生率,疾病組分別為38.30%、62.61%、31.65%,正常妊娠組分別為21.10%、47.25%、17.43%,兩兩相比,差異有統(tǒng)計(jì)學(xué)意義;11.疾病組新生兒的胎兒生長受限、胎兒窘迫、新生兒窒息和圍產(chǎn)兒死亡的發(fā)生率分別為22.25%、33.72%、16.51%和4.13%,正常妊娠組新生兒的上述圍生期結(jié)局的發(fā)生率分別為12.39%、22.02%、8.49%、0.46%,兩組比較,差異有統(tǒng)計(jì)學(xué)意義;結(jié)論:1.高齡(年齡≥35歲)、多胎受孕、試管嬰兒、肥胖等為妊娠期高血壓疾病發(fā)病的危險(xiǎn)因素;2.白細(xì)胞計(jì)數(shù)及其分類與妊娠期高血壓疾病的發(fā)病存在著一定相關(guān)性;3.PLT、PT、FIB可反映妊娠期高血壓疾病的嚴(yán)重程度,監(jiān)測(cè)妊娠期高血壓疾病患者的血小板指標(biāo)及凝血功能可及時(shí)了解病情的進(jìn)展趨勢(shì),能提早預(yù)防嚴(yán)重并發(fā)癥的發(fā)生,減少不良妊娠結(jié)局;4.目前為止,除了終止妊娠外,還沒有有效的PE治療。因此,PE的可靠預(yù)測(cè)因素將在早期預(yù)防和干預(yù)中發(fā)揮重要作用,但其可靠預(yù)測(cè)因素還需進(jìn)一步挖掘。
[Abstract]:Objective: To study the related risk factors and the adverse pregnancy outcome of hypertensive disorder during pregnancy, and to explore the reasonable treatment of hypertensive disorder during pregnancy and to provide the clinical guidance for the diagnosis and treatment of the disease. Methods: The method of retrospective analysis of large samples was used to collect and collect the gynaecology and obstetrics from January 2015 to December 2016 in the first hospital of Lanzhou University. A total of 436 pregnant women were randomly selected for the same time period in the hospital and obstetrics and gynecology in the hospital, and 436 of the normal pregnant women were used as the control group. The general situation, delivery outcome, perinatal outcome, clinical examination index (blood routine, coagulation function) of two groups of pregnant women were collected in detail. The data were analyzed by the independent sample t-test, the second-order test and the statistical method of multi-factor non-conditional logistic regression analysis. Results:1. In the mean age, the mean value of the observation group was greater than that of the control group, and the difference was statistically significant in the two groups. The proportion of the two groups was 44.50% and 36.24%, respectively. The proportion of the two groups was 13.30% and 4.82%, respectively. The proportion of the observation group was 16.51% after IVF-ET and 6.65% in the control group. The proportion of the two groups was 52.06% and 68.35%, respectively. The cultural level (college degree and above), the proportion of the two groups were 40.60% and 56.20%, respectively. The proportion of pregestational BMI (28 kg/ m2) was 50.23% and 43.12%, respectively. The white blood cell count and its classification (lymphocytes, neutrophils) and the mean value of the disease group were all higher than that of the normal pregnancy group, and the difference was statistically significant. The white blood cell count of the mild preeclampsia group and the severe preeclampsia group and the mean value of the classification were compared. The difference was not statistically significant;8. The mean value of PLT, PT, APTT and TT of the disease group was lower than that of the normal pregnancy group. The mean value of PLT, PT, APTT and TT in the preeclampsia group was less than that of the severe preeclampsia group. The mean value of FIB was greater than that of the severe preeclampsia group, and the difference was also statistically significant. The above-mentioned single factors were included in the multi-factor non-conditional logistic regression model. The risk factors of the incidence of HDCP in the elderly, the twin pregnancy, the test tube, the pre-pregnancy BMI, the white blood cell, the neutrophils, PLT, PT and FIB were the protective factors of the HDCP. 10. The incidence of prematurity, cesarean section and postpartum hemorrhage was 38.30%, 62.61%, 31.65%, respectively, and the normal pregnancy group was 21.10%, 47.25% and 17.43%, respectively. The incidence of fetal distress, neonatal asphyxia and perinatal death was 22.25%, 33.72%, 16.51% and 4.13%, respectively. The incidence of the perinatal outcomes in the normal pregnant group was 12.39%, 22.02%, 8.49% and 0.46%, respectively. The difference is of statistical significance; conclusion:1. The risk factors of high-age (35-year-old), multiple-birth pregnancy, test-tube infants, and obesity are the risk factors for hypertensive diseases during pregnancy. The blood cell count and its classification have a certain correlation with the incidence of hypertensive disorder during pregnancy.3. PLT, PT, FIB can reflect the severity of the hypertensive disorder during pregnancy, and the platelet index and the coagulation function of the patients with hypertensive disorder during pregnancy can be well informed of the progress of the disease. the occurrence of serious complications can be prevented early, and the adverse pregnancy outcome can be reduced; So far, there is no effective PE treatment in addition to the termination of pregnancy. As a result, the reliable predictor of PE will play an important role in early prevention and intervention, but its reliable predictor needs to be further mined.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.246
本文編號(hào)：2480393
[Abstract]:Objective: To study the related risk factors and the adverse pregnancy outcome of hypertensive disorder during pregnancy, and to explore the reasonable treatment of hypertensive disorder during pregnancy and to provide the clinical guidance for the diagnosis and treatment of the disease. Methods: The method of retrospective analysis of large samples was used to collect and collect the gynaecology and obstetrics from January 2015 to December 2016 in the first hospital of Lanzhou University. A total of 436 pregnant women were randomly selected for the same time period in the hospital and obstetrics and gynecology in the hospital, and 436 of the normal pregnant women were used as the control group. The general situation, delivery outcome, perinatal outcome, clinical examination index (blood routine, coagulation function) of two groups of pregnant women were collected in detail. The data were analyzed by the independent sample t-test, the second-order test and the statistical method of multi-factor non-conditional logistic regression analysis. Results:1. In the mean age, the mean value of the observation group was greater than that of the control group, and the difference was statistically significant in the two groups. The proportion of the two groups was 44.50% and 36.24%, respectively. The proportion of the two groups was 13.30% and 4.82%, respectively. The proportion of the observation group was 16.51% after IVF-ET and 6.65% in the control group. The proportion of the two groups was 52.06% and 68.35%, respectively. The cultural level (college degree and above), the proportion of the two groups were 40.60% and 56.20%, respectively. The proportion of pregestational BMI (28 kg/ m2) was 50.23% and 43.12%, respectively. The white blood cell count and its classification (lymphocytes, neutrophils) and the mean value of the disease group were all higher than that of the normal pregnancy group, and the difference was statistically significant. The white blood cell count of the mild preeclampsia group and the severe preeclampsia group and the mean value of the classification were compared. The difference was not statistically significant;8. The mean value of PLT, PT, APTT and TT of the disease group was lower than that of the normal pregnancy group. The mean value of PLT, PT, APTT and TT in the preeclampsia group was less than that of the severe preeclampsia group. The mean value of FIB was greater than that of the severe preeclampsia group, and the difference was also statistically significant. The above-mentioned single factors were included in the multi-factor non-conditional logistic regression model. The risk factors of the incidence of HDCP in the elderly, the twin pregnancy, the test tube, the pre-pregnancy BMI, the white blood cell, the neutrophils, PLT, PT and FIB were the protective factors of the HDCP. 10. The incidence of prematurity, cesarean section and postpartum hemorrhage was 38.30%, 62.61%, 31.65%, respectively, and the normal pregnancy group was 21.10%, 47.25% and 17.43%, respectively. The incidence of fetal distress, neonatal asphyxia and perinatal death was 22.25%, 33.72%, 16.51% and 4.13%, respectively. The incidence of the perinatal outcomes in the normal pregnant group was 12.39%, 22.02%, 8.49% and 0.46%, respectively. The difference is of statistical significance; conclusion:1. The risk factors of high-age (35-year-old), multiple-birth pregnancy, test-tube infants, and obesity are the risk factors for hypertensive diseases during pregnancy. The blood cell count and its classification have a certain correlation with the incidence of hypertensive disorder during pregnancy.3. PLT, PT, FIB can reflect the severity of the hypertensive disorder during pregnancy, and the platelet index and the coagulation function of the patients with hypertensive disorder during pregnancy can be well informed of the progress of the disease. the occurrence of serious complications can be prevented early, and the adverse pregnancy outcome can be reduced; So far, there is no effective PE treatment in addition to the termination of pregnancy. As a result, the reliable predictor of PE will play an important role in early prevention and intervention, but its reliable predictor needs to be further mined.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.246
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