PDF(1118 KB)
妊娠合并急性胰腺炎对妊娠结局及新生儿的影响
樊书娟, 向俊西, 肖谧, 王芳会, 林晓洁, 周熙惠, 艾婷, 刘俐
中国当代儿科杂志 ›› 2018, Vol. 20 ›› Issue (4) : 274-278.
PDF(1118 KB)
PDF(1118 KB)
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
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。
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.
Pregnancy / Acute pancreatitis / Complication / Outcome / Neonate
[1] Hacker FM, Whalen PS, Lee VR, et al. Maternal and fetal outcomes of pancreatitis in pregnancy[J]. Am J Obstet Gynecol, 2015, 213(4):568. e1-e5.
[2] Hernandez A, Petrov MS, Brooks DC, et al. Acute pancreatitis and pregnancy:a 10-year single center experience[J]. J Gastrointest Surg, 2007, 11(12):1623-1627.
[3] 王兴鹏, 李兆申, 袁耀宗, 等. 中国急性胰腺炎诊治指南(2013,上海)[J]. 中国实用内科杂志, 2013, 33(7):530-535.
[4] Sweet DG, Carnielli V, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome-2016 update[J]. Neonatology, 2017, 111(2):107-125.
[5] 罗凤珍. 新生儿黄疸[M]//邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学. 第4版. 北京:人民卫生出版社, 2011:267-306.
[6] American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation[J]. Pediatrics, 2004, 114(1):297-316.
[7] 米骏麟, 张燕辉, 郭建平, 等. 新生儿颅内出血的床旁超声诊断价值[J]. 中国临床医学影像杂志, 2015, 26(10):748-749.
[8] Committee on Fetus and Newborn, Adamkin DH. Postnatal glucose homeostasis in late-preterm and term infants[J]. Pediatrics, 2011, 127(3):575-579.
[9] 肖炳华, 黄耿文, 李宜雄, 等. 妊娠期急性胰腺炎:单中心20年52例分析[J]. 中国普通外科杂志, 2014, 23(3):297-300.
[10] Jin J, Yu YH, Zhong M, et al. Analyzing and identifying risk factors for acute pancreatitis with different etiologies in pregnancy[J]. J Matern Fetal Neonatal Med, 2015, 28(3):267-271.
[11] Valdivielso P, Ramírez-Bueno A, Ewald N. Current knowledge of hypertriglyceridemic pancreatitis[J]. Eur J Intern Med, 2014, 25(8):689-694.
[12] Sun L, Li W, Geng Y, et al. Acute pancreatitis in pregnancy[J]. Acta Obstet Gynecol Scand, 2011, 90(6):671-676.
[13] 熊炬, 张彦, 周容. 62例妊娠合并急性胰腺炎不同时期的临床特征及结局分析[J]. 实用妇产科杂志, 2009, 25(6):352-354.
[14] 唐敏, 许建明, 宋莎莎, 等. 妊娠合并急性胰腺炎17例的病情评估及其预后[J]. 中华消化杂志, 2016, 36(4):274-276.
[15] 刘俊燕, 熊涛, 冯虹, 等. 新生儿窒息多器官功能损害的危险因素分析[J]. 中国当代儿科杂志, 2011, 13(12):940-943.
[16] Vilallonga R, Calero-Lillo A, Charco R, et al. Acute pancreatitis during pregnancy, 7-year experience of a tertiary referral center[J]. Cir Esp, 2014, 92(7):468-471.
[17] 李立. 产科并发疾病[M]//丰有吉, 沈铿. 妇产科学. 第2版. 北京:人民卫生出版社, 2010:67-99.
[18] 陈超. 新生儿呼吸窘迫综合症[M]//邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学. 第4版. 北京:人民卫生出版社, 2011:395-398.
[19] Gilbert A, Patenaude V, Abenhaim HA. Acute pancreatitis in pregnancy:a comparison of associated conditions, treatments and complications[J]. J Perinat Med, 2014, 42(5):565-570.
[20] Papadakis EP, Sarigianni M, Mikhailidis DP, et al. Acute pancreatitis in pregnancy:an overview[J]. Eur J Obstet Gynecol Reprod Biol, 2011, 159(2):261-266.
[21] Turhan AN, Gönenç M, Kapan S, et al. Acute biliary pancreatitis related with pregnancy:a 5-year single center experience[J]. Ulus Travma Acil Cerrahi Derg, 2010, 16(2):160-164.
[22] Polydorou A, Karapanos K, Vezakis A, et al. A multimodal approach to acute biliary pancreatitis during pregnancy:a case series[J]. Surg Laparosc Endosc Percutan Tech, 2012, 22(5):429-432.
[23] Juneja SK, Gupta S, Virk SS, et al. Acute pancreatitis in pregnancy:A treatment paradigm based on our hospital experience[J]. Int J Appl Basic Med Res, 2013, 3(2):122-125.
国家自然科学基金（81571477）。
