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目的:探讨影响肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)患者围生儿预后的相关因素。为临床采取恰当的分娩方式和选择适时的手术时机提供可靠依据。方法:随机抽取我院2009年1月-2012年4月发生胎儿窘迫50例与未发生胎儿窘迫的ICP患者50例瘙痒出现孕周、天冬氨酸转氨酶、总胆红素、血清总胆汁酸、脐血流、胎心监护、分娩方式、及新生儿吸入性肺炎、新生儿窒息(Apgar评分)、围生儿死亡率、早产率、小于胎龄儿发生率等进行对比分析,探讨影响ICP患者围生儿预后的因素。结果:发生胎儿窘迫的ICP患者脐血流(S/D值)异常升高及产前胎心监护NST评分、血清总胆汁酸水平、早产率明显高于未发生胎儿窘迫的ICP患者(P<0.05),但瘙痒出现的孕周及AL T、血清总胆红素值,两组间差异无统计学意义(P>0.05)。前组新生儿吸入性肺炎、新生儿窒息、围生儿死亡率均较对照组高,其差异均有统计学意义(P<0.05);两组小于胎龄儿发生率无明显差异,无统计学意义(P>0.05)。结论:脐血流S/D值及血清总胆汁酸、NST评分与ICP患者胎儿窘迫有关,致使新生儿早产率、吸入性肺炎、新生儿窒息、围生儿死亡率均升高,而瘙痒出现的孕周、AL T水平、血清总胆红素水平与之无关。妊娠期ICP严重影响围生儿的预后,应做到早期诊断、早期治疗,适时终止妊娠,降低ICP对围生儿的危害。
Objective: To investigate the related factors of perinatal outcome in patients with intrahepatic cholestasis of pregnancy (ICP). To provide a reliable basis for clinically appropriate mode of delivery and choose a timely operation. Methods: A total of 50 patients with fetal distress in 50 patients with fetal distress and those without fetal distress were randomly selected from January 2009 to April 2012 in our hospital. Pregnancy, aspartate aminotransferase, total bilirubin, serum total bile acid , Cord blood flow, fetal heart rate monitoring, mode of delivery, and neonatal aspiration pneumonia, neonatal asphyxia (Apgar score), perinatal mortality, premature birth rate, the incidence of small gestational age were compared to explore the impact of ICP The prognosis of patients with perinatal factors. Results: Abnormal umbilical blood flow (S / D) and prenatal fetal heart rate monitoring (NST), serum total bile acid (AA) and preterm birth rate were significantly higher in ICP patients with fetal distress than those without fetal distress (P < 0.05). However, gestational age and ALT, total serum bilirubin value of pruritus there was no significant difference between the two groups (P> 0.05). The former group of neonatal aspiration pneumonia, neonatal asphyxia, perinatal mortality were higher than the control group, the difference was statistically significant (P <0.05); two groups of less than gestational age no significant difference in the incidence, no statistics Significance (P> 0.05). Conclusion: S / D of umbilical blood flow, total serum bile acid and NST score are related to fetal distress in patients with ICP, resulting in a rise in neonatal preterm birth rate, aspiration pneumonia, neonatal asphyxia and perinatal mortality, and pruritus Gestational age, AL T level, serum total bilirubin level has nothing to do with it. Pregnancy ICP seriously affect the prognosis of perinatal children, should be early diagnosis and early treatment, timely termination of pregnancy, reduce ICP perinatal harm.