摘要
目的:探讨妊娠期视网膜脱离患者临床发病特点及与围产结局的关系,以提高临床医师对视网膜脱离的认识和处理。方法:回顾性分析天津医科大学总医院2002年3月至2012年3月收治的22例视网膜脱离患者的临床资料。将22例患者按照重度子痫前期临床发病类型分为:突发型组(7例)和渐进型组(15例);按临床发病时间分为:早发型组(11例)和晚发型组(11例)。比较各组并发症及妊娠结局。结果:22例视网膜脱离的患者均为重度子痫前期患者,其中5例合并HELLP综合征,2例合并产前子痫;18例(81.82%)为双眼视网膜脱离,4例(18.18%)单眼视网膜脱离;产前诊断17例(77.27%),产后发生5例(22.73%);剖宫产终止妊娠者21例(95.45%);22例患者入院时均为低蛋白血症患者。早发型组与晚发型组的并发症发生率无显著差异(P>0.05)。22例胎(婴)儿中,6例轻度窒息,2例胎死宫内,3例重度窒息(1例放弃治疗后死亡),死亡率为13.64%(3/22)。突发型组与渐进型组新生儿Apgar评分无统计学差异(P=0.099);早发型组与晚发型组新生儿Apgar评分差异显著(P=0.000),早发型胎(婴)儿结局较晚发型组差。结论:(1)小动脉痉挛、低蛋白血症、溶血可能为重度子痫前期视网膜脱离危险因素;(2)早发型重度子痫前期合并视网膜脱离患者胎(婴)儿结局较差。(3)视网膜脱离作为重度子痫前期严重并发症,是全身各系统脏器灌注减少,发生器质性改变甚至功能衰竭的危险信号。
Objective：To explore the different clinical onset features and perinata｜ out- comes in pregnant womans with retinal detachment and improve the level of understanding and treatment of retinal detachment. Methods： Twenty two cases with retinal detachment admitted in General Hospital of Tianjin Medical University from March 2002 to March 2012 were retrospec- tively analyzed. They were divided into two groups according to the clinical onset type of severe preeclampsia：abrupt onset group （7 cases） and gradual progress group （ 15 cases）. And ac- cording to the clinical onset time they were divided into another two groups：the early-onset group（ 11 cases） and the late-onset group （11 cases）. Complications and perinatal outcomes in each group were evaluated. Results ： （ 1 ） A total of 22 cases were all diagnosed with severe pre- eclampsia, among which 5 were associated with hemolysis, elevated liver enzymes, and low platelets HELLP syndrome, 2 with eclampsia. Retinal detachment is usually bilateral（81.82%） ;77.27% were diagnosed antepartum. All the patients were hypoalbuminemia at the first visit. Cesarean delivery was performed in 95.45%. （2）Abrupt onset group and gradual progress group, early-onset group and late-onset group was not significantly different in the inci- dence of severe complications （ P 〉 0.05 ）. Mild asphyxia, intrauterine fetal death, severe as- phyxia were the perinatal complications of 22 cases in 6,2,3 cases ,respectively. One case of se- vere asphyxia died after giving up baby in early-onset group. The Apgar score of abrupt onset group and gradual progress group was no significant difference （P = 0. 099 ）. Neonatal Apgar score of the early-onset group was significantly higher than the Apgar score of babies in late-on- set group （ P = 0. 000 ）. Conclusions ： （ 1 ） The combination of severe hypertension, hemolysis and hypoalbuminemia in the choroidal vessels may lead to the retinal detachment seen among women with pre-eclampsia/eclampsia. �
出处
《现代妇产科进展》
CSCD
2012年第12期929-932,共4页
Progress in Obstetrics and Gynecology
