不同临床分度妊娠期肝内胆汁淤积症对围产儿结局及分娩方式的影响.pdfVIP

用医院临床杂盍2QI1 箜 鲞笠 147 不同临床分度妊娠期肝 内胆汁淤积症对 围产儿结局及分娩方式的影响 高 岚，梁 红，陈 颖，廖建梅 (成都市妇幼保健院妇产科，四川成都 610031) 【摘要】 目的 探讨不同临床分度妊娠期肝内胆汁淤积症 (intrahepaticcholestasisofpregnancy，ICP)处理时机与方式，以 降低围产儿病率及死亡率。方法 根据发病孕周及孕妇血清胆汁酸、丙氨酸转氨酶、门冬氨酸转氨酶、血清总胆红素、直接胆 红素水乎，将ICP分为轻度与重度，分别予以不同处理，比较其终止妊娠时机和方式与围产儿结局。结果 轻度ICP291例， 重度 ICP183例，终止妊娠孕周分别为(38．3±1．5)周和 (35．2±1．1)周，两组比较差异有统计学意义(P0．O1)；重度组胎儿 宫内窘迫、新生儿窒息、早产发生率均明显高于轻度组，差异有统计学意义 (P0．01)。结论 产前对ICP进行临床分度及处 理，有助于选择终止妊娠时机和分娩方式，从而降低围产儿病率及死亡率。 【关键词】 妊娠；肝 内胆汁淤积；临床分度；围产儿结局 【中图分类号】R714．255 【文献标识码】A 【文章编号】1672—6170(2011)02-0147-03 Intrahepaticcholestasisofpregnancy：Effectofclinicalgrading on perinataloutcomesand modesofdelivery GA0Lan，LIANGHong，CHEN Ying，LIAOJian—mei(DepartmentofObstetricsandGynecology。 WomenandChildrenHospital，Chengdu610031，China) A【bstract】 Objective Todiscussthetreatmentofintrahepaticcholestasisofpregnancy(ICP)indifferentclinicalgrades． Methods Accordingtoonsetdate，theserum bileacid，alaninetransaminase，aspa~icacidtransaminase，serum totaIbiliurbinnad bilirubindirect，ICPwasdividedtwodegrees，mildICPfmildICPgroup)andsevereICP (severICPrgoup)．Differenttreatments weregivenaccordingtoclinicalgrading．OpportunityofpregnancyterminationandperinataloutcomewerecomparedbetweenmildICP andsevereICP．Results Therewere291casesofmildICP．Thetimeofpregnancyterminationwasinthe(38．3±1．5)thgestational weeks．Therewere183casesofsevereICP．Thetimeofpregnancytemr inatio．nwasjnthef35．2±1．1)thgestationalweeks．Dif{_er- encebetweenthetworgoupswassignificant(P0．叭)．Fetaldistressiuuteurs，neonatalasphyxiaandincideneeofprematuredeliv— eryinseverICPgroupweresignificantlyhigherthanthoseinmildICPrgoup (P0．001)．Conclusion Itissuggestedtodetermine theopportunityofpregnancyterminationandthemodesofdeliveryaccordingtodifierentclinicalgradesandtreatmentsofICP． K【eyWords】 Pregna