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目的:探讨妊娠高血压合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者应用持续气道正压通气(CPAP)治疗对母儿结果的影响,为临床治疗提供依据。方法:选择经PSG检查确诊为OSAHS的患者117例,将能耐受坚持CPAP治疗者设为干预组(70例),未用CPAP治疗者设为对照组(47例)。对照组只接受常规药物治疗;而干预组除常规药物治疗外,同时接受CPAP治疗,并在随后的产前保健和产后过程中,记录妊娠高血压合并OSAHS孕妇的母儿结果。结果:与对照组比较,轻度、中度OSAHS孕妇中剖宫产和产后出血差异均无统计学意义(P>0.05);重度OSAHS孕妇中剖宫产、产后出血差异均有统计学意义(P<0.05或P<0.01)。与对照组比较,轻度OSAHS孕妇中新生儿窒息、胎儿生长受限、胎儿窘迫差异均无统计学意义(P>0.05);中度OSAHS孕妇中胎儿生长受限、胎儿窘迫差异有统计学意义(P<0.05);重度OSAHS孕妇中新生儿窒息、胎儿生长受限、胎儿窘迫差异均有统计学意义(P<0.05或P<0.01)。结论:妊娠高血压妇女尤其是有OSAHS高危因素者,应详细询问病史并注意是否有OSAHS的症状,一旦怀疑OSAHS,需行PSG检查。特别对于重度OSAHS的妊娠高血压患者强烈建议分娩前及早应用CPAP治疗,CPAP是一种安全有效的治疗妊娠高血压合并OSAHS的方法。
Objective: To investigate the effect of continuous positive airway pressure (CPAP) therapy on pregnancy outcome in patients with pregnancy-induced hypertension and obstructive sleep apnea-hypopnea syndrome (OSAHS), and to provide basis for clinical treatment. Methods: A total of 117 patients with OSAHS confirmed by PSG were selected. The patients who could tolerate CPAP were treated as intervention group (n = 70) and those without CPAP as control group (n = 47). The control group received only conventional drug treatment; while the intervention group received CPAP treatment in addition to conventional drug treatment, and in the subsequent prenatal care and postpartum process, maternal and neonatal results of pregnancy-induced hypertension and OSAHS pregnant women were recorded. Results: Compared with the control group, there was no significant difference in cesarean section and postpartum hemorrhage between mild and moderate OSAHS pregnant women (P> 0.05). There were significant differences in cesarean section and postpartum hemorrhage between severe OSAHS pregnant women ( P <0.05 or P <0.01). Compared with the control group, mild OSAHS pregnant women, neonatal asphyxia, fetal growth restriction, fetal distress differences were not statistically significant (P> 0.05); moderate OSAHS pregnant women, fetal growth restriction, fetal distress difference was statistically significant (P <0.05). Neonatal asphyxia, fetal growth restriction and fetal distress in severe OSAHS pregnant women were significantly different (P <0.05 or P <0.01). CONCLUSIONS: Women with pregnancy-induced hypertension, especially those at high risk of OSAHS, should be asked about their medical history in detail and to be aware of any OSAHS symptoms. Once OSAHS is suspected, PSG should be performed. Especially for patients with severe pregnancy-induced hypertension, OSAHS is strongly recommended to use CPAP immediately before delivery, which is a safe and effective method for the treatment of pregnancy-induced hypertension complicated with OSAHS.