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不同病因妊娠合并急性胰腺炎患者的临床特征及母婴预后研究

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Analysis of Clinical Characteristics and Maternal and Neonatal Outcomes in Pregnancy Complicated with Acute Pancreatitis Patients of Different Etiologies

摘要: 背景 由于经济发展及国内生育政策改变,妊娠合并急性胰腺炎(APIP)发病率逐渐增加,不同病因的 APIP 临床特点不同,且对母婴的预后可能存在较大差异,既往对此研究较少。目的 分析不同病因 APIP 的临床特征及与母婴预后的关系。方法 收集 2016—2022 年首都医科大学附属北京友谊医院收治的 48 例住院 APIP 患者的临床资料,根据病因分为胆源性组(n=27)及高脂血症组(n=21),分析对比两组实验室指标以及母婴结局。结果 胆源性组起病至就诊时间长于高脂血症组,入院时孕周小于高脂血症组,既往孕次多于高脂血症组,腹泻及停止排便所占比例低于高脂血症组(P<0.05)。两组患者严重程度比较,差异无统计学意义(P=0.912)。胆源性组血红蛋白、血小板、C 反应蛋白、胆固醇、三酰甘油水平低于高脂血症组,总胆红素、直接胆红素、丙氨酸转氨酶、碱性磷酸酶、谷氨酰转肽酶、血肌酐、血钙、血钠、血淀粉酶、N 末端脑钠肽前体水平高于高脂血症组(P<0.05)。胆源性组分娩时孕周短于高脂血症组(P<0.05)。胆源性组和高脂血症组早产率、剖宫产率、剖宫产人为干预终止妊娠率比较,差异均无统计学意义(P>0.05)。胆源性组新生儿重量小于高脂血症组,身长短于高脂血症组,病理性黄疸、呼吸窘迫、呼吸机辅助呼吸发生率高于高脂血症组(P<0.05)。结论 胆源性疾病目前仍为 APIP 患者的第一位病因,可显著缩短母体的分娩孕周,并造成胎儿低体质量,增加胎儿病理性黄疸、呼吸窘迫、呼吸机辅助呼吸的发生率,引起胎儿更为严重的预后。
 
Abstract: Background Due to economic development changes in domestic fertility policy,the incidence of acute pancreatitis in pregnancy(APIP) has been gradually increasing. The clinical characteristics of APIP of different etiologies are different,and there may be significant differences in the prognosis for mothers and infants,but previous studies on this are relatively few. Objective To analyze the clinical characteristics and maternal and neonatal outcomes in pregnancy complicated with acute pancreatitis patients of different etiologies. Methods A total of 48 inpatients with APIP in Beijing Friendship Hospital affiliated to Capital Medical University from 2016 to 2022 were collected,which were divided into the biliary group(n=27)and hyperlipidemic group(n=21). The laboratory indicators and maternal and infant outcomes in the two groups were compared. Results The biliary group had a longer time of onset to visit,a smaller gestational week at admission,more previous pregnancies,and lower percentage of diarrhea and cessation of defecation than the hyperlipidemic group(P<0.05).There was no statistically significant difference in severity between the two groups of patients(P=0.912). The levels of hemoglobin,platelets,C-reactive protein,cholesterol,and triacylglycerol in the biliary group were lower than those in the hyperlipidemia group,while the levels of total bilirubin,direct bilirubin,alanine transaminase,alkaline phosphatase,glutamyltranspeptidase,creatinine,calcium,sodium,amylase,and N-terminal brain natriuretic peptide precursor were higher than those in the hyperlipidemia group(P<0.05). The gestational week at delivery of the biliary group was shorter than the hyperlipidemia group(P<0.05). There was no statistically significant difference in premature delivery rate,cesarean section rate,and artificial intervention termination of pregnancy rate between the biliary group and hyperlipidemia group(P>0.05). The birth weight of the biliary group was smaller than the hyperlipidemia group,while the birth length was shorter than the hyperlipidemia group. The incidence of neonatal jaundice,respiratory distress,and ventilator-assisted breathing was higher than the hyperlipidemia group(P<0.05). Conclusion Biliary diseases are still the first cause of APIP patients,which can significantly shorten the maternal gestational week,cause low fetal body mass,increase the incidence of pathological jaundice,respiratory distress,and ventilator-assisted breathing in the fetus,leading to a more severe prognosis for the fetus.
 

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[V1] 2023-11-23 18:02:45 ChinaXiv:202311.00218V1 下载全文
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