重度子痫前期合并胎儿生长受限经羊膜腔灌注治疗后结局研究.docVIP

重度子痫前期合并胎儿生长受限经羊膜腔灌注治疗后结局研究【摘要】 目的 探讨重度子痫前期合并胎儿生长受限经羊膜腔灌注治疗后的妊娠结局。方法 分析1997年1月至2010年10月在我院系统产检、分娩的重度子痫前期合并胎儿生长受限的孕妇共40例，予羊膜腔内灌注小儿复方氨基酸100 ml(A组)，同期抽取重度子痫前期合并胎儿生长受限的孕产妇36例(B组)。并对两组的妊娠结局及围生儿预后进行对比分析。结果 重度子痫前期合并胎儿生长受限治疗组(A组)新生儿窒息、早产、新生儿呼吸窘迫综合征、新生儿肺炎，高胆红素血症、低出生体重儿的发生率显著降低。结论 重度子痫前期合并胎儿生长受限是一种严重危害围生儿的疾病，积极的处理有助于改善围生儿的预后。? 【关键词】 重度子痫前期；胎儿生长受限；羊膜腔灌注术；围生儿结局 ?? Analysis of perinatal results of severe preeclampsia complicated with fet al growth restriction by amniotic infusion GUO Ying, ZHANG Yu-jie, KANG Jia-li. The affilicated Guangzhou First People?s Hospital of Guangzhou Medical CollegeGuangdong,510180 China ? 【Abstract】 Objective To explore the pregnancy results of Severe preeclampsia complicated with fetal Growth Restriction by amniotic infusionMethods Forty cases of severe preeclampsia complicated with FGR had received prenatal care systematically and delivered in our hospital from Tan 1997 to OCT 2010(A group). Pediatric compound amino acid 100 ml was perfused into the amniotic cavity.And thirty six cases of severe preeclampsia complicated with FGRwere selected at the same time(B group).The pregnancy results and prognosis of perineonates in the two groups were compared.Results The incidence of neonatal asphyxia, premature labor, meonatal respiratory distress sydrome,neonate pneumonia,hyperbilirubinemia,fetal growth restriction were significantly decreased on the therapy group(A group) (P 早产仍是重度子痫前期合并FGR围生儿死亡的重要原因，选择适宜的孕周终止妊娠对改善重度子痫前期合并FGR围生儿预后有重要意义。故对于子痫前期合并FGR的孕妇，在控制母体病情的前提下能尽量延长孕周，提高胎儿的体重可降低围生儿的发病率和死亡率。传统治疗FGR多通过母体给药的间接方法，药物在母体内经过吸收和代谢并受到胎盘屏障的限制，到达胎儿体内的药物浓度有限且有延迟性；且由于重度子痫前期胎盘绒毛间隙提早关闭，此时母体的治疗措施已无法通过改善胎盘传递营养物的途径达到纠正FGR的目的；胎儿在慢性缺氧情况下，略有宫缩，胎盘储备功能丧失，即可有胎儿猝死发生。Mulvihill SJ［2］做动物试验发现在兔子羊膜腔内注入氨基酸及葡萄糖能明显促进兔子肝、大脑、躯干的发育。本研究利用宫内治疗的手段，避开胎盘屏障，于羊水中注入小儿氨基酸，通过胎儿吞咽羊水经胃肠道吸收营养物质，促进胎儿发育。邢爱云等［3］比较宫内注射与母体静脉输注复合氨基酸治疗FGR，于治疗后4 h查胎儿脐血中氨基酸浓度明显增加。提示羊水中的氨基酸能更有效地让胎儿吸收利用。而纠正了胎儿生长受限的同时也增强了胎儿的耐受力，从而减少了胎儿窘迫的发生率。当合并羊水过少时，同时予注入适量0.9%生理盐水等羊水替代液，有效地治疗羊水过少，延长了孕周，预防胎儿窘迫的