妊娠合并急性胰腺炎对妊娠结局及新生儿的影响

Influence of acute pancreatitis in pregnancy on pregnancy outcomes and neonates

摘要:

目的 探讨妊娠合并急性胰腺炎（APIP）对妊娠结局及新生儿的影响。方法 以33例APIP患者及其31例活产新生儿为研究对象，对孕产妇及其新生儿进行回顾性分析。结果 33例APIP中发生于妊娠晚期的最多（26例，79%）。从病因分析，以高脂血症性最多（14例，45%），胆源性13例（42%），其他类型4例（13%）；从严重程度分析，以轻度最多（22例，67%），中度最少（5例，15%）。33例APIP患者中病死率为0。足月分娩的20例中终止妊娠的11例，早产10例中终止妊娠的9例，2例发生胎死宫内，1例于孕中期发生流产。31例活产新生儿（其中2例为双胎）中1例（3%）死亡，12例（39%）发生新生儿高胆红素血症，8例（26%）发生新生儿低血糖症，6例（19%）发生新生儿呼吸窘迫综合征，5例（16%）发生感染性疾病，2例（6%）发生颅内出血。胆源性、高脂血症性和其他类型所致APIP 3组所娩新生儿中早产儿的比例、出生体重以及新生儿各疾病发生率的差异均无统计学意义（P > 0.05），但终止妊娠以高脂血症性APIP组最多（P < 0.05）。轻、中、重度3组以中度组娩出的早产儿最多（P < 0.05）；所娩新生儿的出生体重以中度组最低（P < 0.05）；所娩新生儿呼吸窘迫综合征、颅内出血、感染性疾病的发生率以轻度组最低（P < 0.05）。结论 妊娠合并急性胰腺炎可导致不良妊娠结局和新生儿疾病发生，并且与胰腺炎的严重程度相关。

Abstract:

Objective To study the influence of acute pancreatitis in pregnancy (APIP) on pregnancy outcomes and neonates. Methods A retrospective analysis was performed for 33 APIP patients and 31 neonates born alive. Results Of the 33 APIP patients, 26 (79%) developed APIP in the late pregnancy. Fourteen (45%) patients had hyperlipidemic APIP, 13 (42%) had biliary APIP, and 4 (13%) had other types of APIP. According to the severity, 22 (67%) were mild APIP, 5 (15%) were moderate APIP, and 6 were severe APIP. None of the 33 APIP patients died. Among the 20 patients with term delivery, 11 underwent termination of pregnancy; among the 10 patients with preterm delivery, 9 underwent termination of pregnancy; two patients experienced intrauterine fetal death, and one experienced abortion during the second trimester. Among the 31 neonates born alive (two of them were twins), 1 (3%) died, 12 (39%) experienced neonatal hyperbilirubinemia, 8 (26%) had neonatal hypoglycemia, 6 (19%) had neonatal respiratory distress syndrome, 5 (16%) experienced infectious diseases, and 2 (6%) experienced intracranial hemorrhage. The hyperlipidemic APIP group had a higher percentage of patients undergoing termination of pregnancy than the biliary APIP and other types of APIP groups (P < 0.05). The incidence rate of preterm infants in the moderate APIP was higher than in the mild and severe APIP groups (P < 0.05). The mean birth weights of neonates were the lowest in the moderate APIP group. The incidence rates of neonatal respiratory distress syndrome, intracranial hemorrhage, and infectious disease were the lowest in the mild APIP group (P < 0.05). Conclusions APIP can lead to adverse pregnancy outcomes and neonatal diseases, which are associated with the severity of pancreatitis.