摘要
目的:探讨妊娠期肝内胆汁淤积症(Intrahepati ccholestasis of pregnancy,ICP)的妊娠终止时机和方式。方法:选择2007年1月至2008年6月在我院住院并分娩的200例ICP。记录是否有皮肤瘙痒、肝功能结果、血甘胆酸(Glycocholic Acid,CG)、羊水污染情况、分娩方式、分娩孕周、新生儿Apgar评分。根据CG结果,将病例分为A组(甘胆酸<1000μg/dl),B组(1000μg/dl≤甘胆酸<3000μg/dl),C组(甘胆酸≥3000μg/dl)。结果:1.三组间CG越高,谷丙转氨酶(ALT)、天冬氨酸转移酶(AST),总胆汁酸、总胆红素异常升高的比例也越高。2.羊水过少发生率无差异。羊水粪染有显著性差异。3.三组比较CG值越高,小孕周分娩比例越高。4.三组间分娩方式比较有显著性差异。CG值越高,剖宫产率越高。5.随着CG水平的升高,皮肤瘙痒更严重。结论:CG是ICP诊断评价、制定治疗方案的敏感指标,如果CG值小于1000μg/dl,可在严密监护下阴道分娩。
Objective： To explore the opportunity and the manner of termination of pregnancy. Methods： The data of 200 cases of ICP from January 2007 to June 2008 were retrospectively analyzed.Maternal pruritis, liver function , glycocholic acid（CG）, amniotic fluid condition, the time and the way of termination of pregnancy, Apgar score were examined.Three groups were classified by the values of CG ： Group A （CG〈1000 μg/dl）,GroupB（1 000 μg/dl≤CG〈3 000 μg/dl）,and Group C（CG≥ 3 000 μg/dl）.Results：The increased rates of total bilirubin alanine aminotransferase, aspartate aminotransferase, total bile aacid increased with the increase of the values of CG. There was no significant difference in the incidence of hypamnion. The incidence of meconium stained were statistically different. The gestational weeks of preterm delivery increased, with the increase of the values of CG, with the statistical different. The preterm delivery manner was statistically different.The higher CG, the higher cesarean section rate. The incidence of pruritus was statistically different, the higher CG, the mere severe pruritus. Conclusion： The guidelines for treatment of ICP introduced the assessment of serum values of CG in diagnostics as the most important indicator. When the disease is aggravate or to recur after treatment, delivery was recommended in the 32 th-34 th week when lung maturity had been established by using dexamethasone.Mostly patients of ICP labour in 37 weeks gestation delivery, when the values of CG was 〈3 000 μg/dl. The incidence of cesarean section was high.If the values of CG was〈 1 000 μg/dl, vaginal delivery was feasible under careful monitoring.
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2009年第3期349-352,共4页
Journal of Chongqing Medical University
