摘要
目的:探究妊娠中晚期急性胰腺炎(APMLP)并发胎儿不良结局的危险因素,指导早期识别与临床干预、改善母儿预后。方法:回顾我院2011年至2020年的APMLP病例,比较胎儿不良结局和足月分娩两组患者的临床特点,并寻找胎儿不良结局的危险因素。结果:APMLP患者40例,发病率0.263%,无孕产妇死亡,胎儿不良结局组共20例,发生率为50%。不良结局组的中重症/重症急性胰腺炎和产前穿刺引流的比例明显高于足月分娩组,不良结局组产前保守治疗和早期肠内营养的比例明显低于足月分娩组,差异有统计学意义(P<0.05)。单因素二元Logistic回归分析示:APMLP为轻症(OR 0.104,95%CI 0.016~0.674,P=0.018)、早期肠内营养(OR 0.167,95%CI 0.030~0.924,P=0.040)、保守治疗(OR 0.111,95%CI 0.020~0.610,P=0.011)是胎儿不良结局的保护性因素;胰腺/胰周局部并发症需穿刺引流(OR 7.364,95%CI 1.337~40.548,P=0.022)是胎儿不良结局的危险因素。结论:胰腺/胰周的局部并发症需穿刺引流是APMLP并发胎儿不良结局的危险因素,应早期识别,并尽可能避免穿刺引流以改善胎儿不良结局。
Objective:To explore the risk factors of fetal adverse outcomes in acute pancreatitis during mid-to-late pregnancy(APMLP),then guide the early identification and clinical intervention to improve the prognosis of mother and fetus.Methods:The cases of APMLP in our hospital from 2011 to 2020 were reviewed.The clinical characteristics of the two groups of patients with adverse fetal outcomes and term delivery were compared,the risk factors of adverse fetal outcomes were evaluated.Results:40 cases were included,no maternal death,with an incidence of 0.263%.There were 20 patients with adverse fetal outcomes group,and the incidence of adverse fetal outcomes was 50%.The percentage of moderate severe/severe acute pancreatitis and puncture drainage in the adverse outcomes group was significantly higher than that in the term delivery group(P<0.05),while the percentage of conservative treatment and early enteral nutrition in the adverse outcomes group was significantly lower than that in the term delivery group(P<0.05).Univariate binary Logistic regression analysis showed that mild acute pancreatitis(MAP)(OR 0.104,95%CI 0.016-0.674,P=0.018),early enteral nutrition(OR 0.167,95%CI 0.030-0.924,P=0.040),and conservative treatment(OR 0.111,95%CI 0.020-0.610,P=0.011)were protective factors against adverse fetal outcomes;Pancreatic/peripancreatic local complications requiring puncture and drainage(OR 7.364,95%CI 1.337-40.548,P=0.022)was a risk factor of adverse fetal outcomes.Conclusions:Pancreatic/peripancreatic local complications requiring puncture drainage is a risk factor for adverse fetal outcomesin APMLP.APMLP patients with pancreatic/peripancreatic local complications should be identified early,puncture and drainage should be avoided as much as possible to improve the adverse fetal outcomes.
作者
黄鹏
周煦
李玉姬
陈艳红
雷衍军
HUANG Li;ZHOU Xu;LI Yuji(Department of Critical Care Medicine,Hunan Provincial People's Hospital(The First-Affiliated Hospital of Hunan Normal University),Changsha Hunan 410005,China)
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2023年第2期137-141,共5页
Journal of Practical Obstetrics and Gynecology
关键词
急性胰腺炎
妊娠中晚期
胎儿不良结局
胰腺/胰周局部并发症
Acute pancreatitis
Mid-to-late pregnancy
Adverse fetal outcomes
Pancreatic/peripancreaticlocal complications
