【www.zhangdahai.com--学生个人工作总结】
[摘要] 目的：探讨妊娠期肝内胆汁淤积症妊娠结局对母婴的影响。方法：60例肝内胆汁淤积症（ICP）患者为ICP组，取同期60例正常孕妇为对照组，对妊娠结局进行回顾性分析。结果：妊娠期肝内胆汁淤积综合征组并发症，如肝功能受损、血小板减少、早产等与对照组相比明显增加，胎儿窘迫发生例数、剖宫产率、早产儿及新生儿窒息等发生均高于对照组（P＜0.05)。结论：妊娠期肝内胆汁淤积症对母婴危害大，早产、胎儿窘迫及围生儿并发症，死亡率明显高于正常孕妇组，加强对ICP组的产前监护及管理，尽量改善母婴结局。
[关键词] 妊娠期；肝内胆汁淤积综合征；并发症；母婴
[中图分类号] R714 [文献标识码]A[文章编号]1674-4721（2011）03（c）-034-02
Clinical analysis of maternal and neonatal outcomes about sixty cases of intrahepatic cholestasis of pregnancy
LAN Xiaoling
Maternal and Child Health Hospital of Nanhai District, Foshan City, Guangdong Province, Foshan 528200, China
[Abstract] Objective: To investigate the intrahepatic cholestasis of pregnancy on maternal outcome of pregnancy. Methods: 60 patients with intrahepatic cholestasis (ICP) ICP group of patients, 60 normal pregnant women to take over the same period as the control group, on pregnancy outcome were analyzed retrospectively. Results: The intrahepatic cholestasis syndrome group complications such as impaired liver function, thrombocytopenia, premature delivery compared with the control group significantly increased the number of cases of fetal distress, cesarean section rate and neonatal asphyxia in preterm children such as occurred were higher (P0.05)，具有可比性。
1.2 诊断标准
ICP诊断标准参见第6版《妇产科学》[1]：瘙痒；血清胆酸升高；血清丙氨酸氨基转移酶、天冬氨酸氨基转移酶升高：甲、乙、丙型肝炎的病毒标志物均为阴性；排除其他能引起瘙痒、黄疸和肝功能异常的疾病。早产定义为妊娠满28周至不满37周间分娩者。肝功能受损指谷丙转氨酶及谷草转氨酶均大于80 U/L。血小板减少症指血小板计数 临床上对ICP的处理原则是促胆红素排泄，保肝，消除黄疸及瘙痒，补充维生素K，临床上使用较多的为S-腺苷基-L-蛋氨酸，它刺激膜的磷脂合成通过使肝浆膜磷脂成分的增加防止雌激素所引起的胆汁淤积[8]。
ICP患者的胎儿在宫内变化往往特别突然，有时常规产前监护无法预测[9-10]，易发生胎儿猝死。但积极的胎儿监护是必要的，方法主要包括NST及胎动计数，根据临床经验，凡是瘙痒、黄疸明显的孕妇，胎儿死亡率高，故此类患者在37周应入院待产，积极主动干预。对于孕周小于37周的孕妇，自觉胎动减少，或者胎心监护提示无反应，监测胆汁酸进行性升高，如何选择终止妊娠的时机相当重要，必要时可行羊水泡沫实验检测胎肺是否成熟，同时可观察羊水是否浑浊，若羊水浑浊提示胎儿窘迫，可考虑剖宫产终止妊娠，胎肺不成熟，羊水清亮可注入地塞米松促胎肺成熟。对于37周后的患者，宫颈成熟可提前人工破膜了解羊水性状，及早发现羊水污染患者，避免胎儿窘迫发生。对于ICP患者早期诊断，密切监护，对于改善妊娠结局相当重要，尽可能减少母婴并发症，确保母婴安全。
[参考文献]
[1]乐杰.妇产科学[M].6版.北京:人民卫生出版社,2003:107-108.
[2]Alonso JR,Milcnko B,Irankovic,et al.Intrahepatic cholesterasis of pregnancy：a retrospective casecontrol study of perinatal outcome[J].Am J obstet Gynecol,1994,170(3):891.
[3]Puel T,Beuers U.Intrahepetic cholestasis of pregnancy[J].Orphanet J Rare Dis,2007,29(2):26.
[4]沈叶群.36例妊娠期肝内胆汁淤积症临床分析[J].中国现代医生,2009,47(28):141.
[5]Sopulveda WH,Gonzalez C,Cruz MA,et al.Vasoconstrictive effect of bile acid on isolated human placental chorionic veins[J].Eur J Obster Gynecol Reprod Biol,1991,42(2):211-215.
[6]Laatikainen T,Tulenheimo A.Maternal serum bileacid levels and fetal distress in cholestasis of pregnancy[J].Int J Gynecol Obstet,1984,22(3):90-91.
[7]刘伯宁,戴钟英,沈宁,等.妊娠期肝内胆汁淤积症胎盘组织计量测定[J].中华妇产科杂志,1988,23(2):9-10.
[8]李绍雄.妊娠期肝内胆汁淤积症对围产儿预后的影响[J].保健医学研究与实践,2009,6(4):16-18.
[9]Williamson C,Hems LM,Coulis DG,et al.Clinical outcome in a series of cases of obstetric cholestasis identified via a patient support group[J].BJOG,2004,111(7):676-681.
[10]Sentilhee L,Venspyck E,Pia P,et al.Fetal death in a patient with intrahepatic cholesterasis of pregnancy[J].Obstet Gynecol,2006,107(2):458-460.
（收稿日期：2011-01-13）
注：本文中所涉及到的图表、注解、公式等内容请以PDF格式阅读原文
