【摘要】 目的 分析妊娠期肾病综合征(NSP)的临床特点,探讨处理策略。方法 回顾性分析2002—2006年42例妊娠期肾病综合征的妊娠结局、并发症、终止妊娠的时机。结果 孕妇并发腹水38例,行剖宫产终止妊娠34例,水囊引产8例,围生儿死亡6例。结论 NSP是严重影响母儿预后的妊娠期并发症,尽早识别、正确处理是改善母婴结局的关键。
【关键词】 妊娠;肾病综合征;并发症
Clinical features and disposal strategies of nephritic syndrome during pregnancy
LIN Ping JIANG Shufang
Department of Gynaeclolgy and Obstetrics ,Yishui Central Hospital 276400
【Abstract】 Objective To analyze the clinical features of nephritic syndrome during pregnancy(NSP) and approach its disposal strategies.Methods Retrospective analysis was taken to 42 cases of NSP from 2002 to 2006,including their pregnancy outcomes,complications,modalities of termination of pregnancy,Perinatal outcomes and therapy methods.Results 38 pregnancy women complicating ascitic fluid,34 terminations of pregnancy by uterineincision delivery,8 inductions of labor with water bag,6 perinatal deaths.Conclusion Severe dropsy and ascitic liuid are outstanding features of NSP,2 complication during pregnancy,by which mother and infants prognosis was severely influenced,and diagnosis earlier and disposal properly is the key point to improve mother and infants results.
【Key words】 pregnancy,nephritic syndrome,complication
妊娠期肾病综合征(NSP)是产科少见而严重的疾病,是妊娠高血压疾病的一种特殊类型,可导致孕产妇及围生儿不良结局,因此,提高对NSP疾病的认识,了解其临床特点,掌握其处理策略,预防并发症发生,对降低孕产妇及围生儿死亡是十分重要的。
1 临床资料
11 临床资料 我院自2002年1月—2006年10月共有12 680名产妇分娩,重度子痫前期患者286例,其中42例为妊娠期肾病综合征,NSP占分娩总数的033%,占重度子痫前期的147%,患者年龄22~36岁,平均29岁,初产妇29例,经产妇13例,确诊疾病的孕周分布在17+5~37+3周,平均30+5周,其中<28周2例,28~32周24例,32~34周11例,>34周5例。
12 临床表现及辅助检查 ①所有患者均以水肿、高血压就诊,3例患者感头痛、头晕、视物模糊,1例患者抽搐入院。②收缩压145~200 mm Hg。③白蛋白为182~298 g/L,24 h尿蛋白定量为39~128 g,血清总胆固醇为79~144 mmol/L,7例尿素氮升高,4例肝功能受损。④42例患者腹部检查及彩超检查胎儿均小于孕周。
13 诊断标准 肾病综合征按《妇产科疾病诊断标准》[1]:①大量蛋白尿(尿蛋白>35 g/24 h);②高脂血症(血清胆固醇>777 mmol/L);③高度水肿;④低蛋白血症(血浆白蛋白<30 g/L)。
2 结果
21 围生儿情况 42例患者中双胎1例,围生儿共43例,42例系早产儿,终止妊娠孕周为28+3~37+4周,
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