中晚期妊娠阻塞性睡眠呼吸暂...低通气综合征对母儿结局影响_张丽敏.pdf

论著中晚期妊娠阻塞性睡眠呼吸暂停低通气综合征对母儿结局影响张丽敏，刘丽，杨金丽基金项目:广西卫生健康委科研课题(编号:Z20190911)作者单位:545005柳州，广西医科大学附属柳州市工人医院产科作者简介:张丽敏，医学硕士，主治医师，研究方向:优生遗传。E-mail:374790513 qq com通信作者:刘丽，医学硕士，副主任医师，研究方向:围产医学。E-mail:53950293 qq com 摘要 目的探讨中晚期妊娠阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对母儿结局影响。方法对 2020 年 3 月至 2021 年 3 月广西医科大学附属柳州市工人医院收治的 156 例孕妇进行呼吸睡眠障碍筛查，42 例孕妇患 OSAHS 为 OSAHS 组，114 例孕妇未患 OSAHS 为非 OSAHS 组。比较两组孕妇临床特征及母儿结局。结果两组中有高血压病史、糖尿病病史、甲状腺功能减退、OSAHS 家族史的人数比例差异均无统计学意义(P 0.05)。孕妇不同预产期年龄组(25 岁、25 34 岁、35 岁)中 OSAHS 患病率分别为 16.7%、23.7%、38.9%，呈上升趋势。在孕中期和孕晚期 OSAHS 患病率随 BMI 的增长亦呈上升趋势。OSAHS 组中妊娠期高血压疾病、妊娠期糖尿病发生率(分别为 47.6%、47.6%)显著高于非 OSAHS 组(分别为 8.8%、29.8%)(P 0.05)。两组胎儿生长受限、羊水过少、死产或死胎、早产、剖宫产、产后出血发生率比较差异无统计学意义(P 0.05)。OSAHS 组低出生体重儿发生率(28.6%)高于非 OSAHS 组(8.8%)(P 0.05)。两组新生儿窒息发生率比较差异无统计学意义(P 0.05)。结论妊娠期 OSAHS 患病率随孕妇 BMI 水平增加而上升。妊娠期OSAHS 与妊娠期高血压疾病、妊娠期糖尿病、低出生体重儿的发生密切相关。应加强孕期 OSAHS 知识的宣教以及筛查，指导患者改变生活方式，必要时给予医疗干预以改善孕期 OSAHS 情况。关键词 阻塞性睡眠呼吸暂停;母儿结局;妊娠期高血压疾病;妊娠期糖尿病 中图分类号 714.25 文献标识码 A 文章编号 1674 3806(2023)02 0168 05doi:10 3969/j issn 1674 3806 2023 02 14Effects of obstructive sleep apnea hypopnea syndrome on maternal and infant outcomes in the pregnant womenin the second and third trimestersZHANG Li-min，LIU Li，YANG Jin-li Department of Obstetrics，Liuzhou WorkersHospital Affiliated to Guangxi Medical University，Liuzhou 545005，China Abstract ObjectiveTo explore the effects of obstructive sleep apnea hypopnea syndrome(OSAHS)on maternaland infant outcomes in the pregnant women in the second and third trimesters MethodsOne hundred and fifty-six preg-nant women who were admitted to Liuzhou Workers Hospital Affiliated to Guangxi Medical University from March 2020to March 2021 were screened for respiratory and sleep disorders，and according to the screened results，the pregnantwomen were assigned into the OSAHS group(n=42)and the non-OSAHS group(n=114)The clinical characteris-tics，maternal and infant outcomes were compared between the two groups esultsThere was no significant differ-ence in the proportion of the patients with a history of hypertension，a history of diabetes，hypothyroidism and familyhistory of OSAHS(P 0.05)The prevalence rates of OSAHS in the pregnant women of different age groups(25 yearsold，25-34 years old and 35 years old)at the expected delivery periods were 16.7%，23.7%and 38.9%，respec-tively，showing an upward trend The prevalence rate of OSAHS increased with the increase of body mass index(BMI)inthe second and third trimesters of pregnancy The incidence rates of hypertensive disorder complicating pregnancy(HDCP)in the third trimester，gestational diabetes mellitus(GDM)in the OSAHS group(47.6%and 47.6%，respectively)weresignificantly higher than those in the non-OSAHS group(8.8%and 29.8%，respectively)(P 0.05)，and there wereno significant differences in the incidence rates of fetal growth restriction(FG)，oligohydramnios，stillbirth or stillbornfoetus，preterm birth，cesarean section and postpartum hemorrhage between the two groups(P 0.05)The incidence861Chinese Journal of New Clinical Medicine，February 2023，Volume 16，Number 2of low birth weight infants in the OSAHS group(28.6%)was higher than that in the non-OSAHS group(8.8%)(P 0.05)There was no significant difference in the incidence rate of neonatal asphyxia between the two groups(P 0.05)ConclusionWith the increase of BMI level，the prevalence of OSAHS during pregnancy increases gradually OSAHSof pregnant women is closely related to the occurrence of HDCP，GDM and low birth weight infants Therefore，the knowl-edge of dissemination and screening about OSAHS during pregnancy should be strengthened，and the OSAHS duringpregnancy should be improved through guiding the life-style changes of the patients and performing medical interven-tion when necessary Key words Obstructive sleep apnea;Maternal and infant outcomes;Hypertensive disorder complicatingpregnancy(HDCP);Gestational diabetes mellitus(GDM)阻塞性睡眠呼吸暂停低通气综合征(obstructivesleep apnea hypopnea syndrome，OSAHS)是以睡眠过程中由于上气道阻塞引起反复、频繁发生呼吸暂停和低通气为特点的睡眠呼吸障碍性疾病。妊娠期由于生理因素、激素水平等的特殊变化，孕期 OSAHS 的患病率明显高于非孕期 1。国内外研究报道孕期合并OSAHS 是一系列母儿不良结局的危险因素，如妊娠期高血压疾病、妊娠期糖尿病、早产、胎儿生长受限、新生儿窒息等，严重威胁孕妇及新生儿的安全 2-4。本研究主要分析 OSAHS 对母儿结局的影响，现报道如下。1资料与方法1.1一般资料回顾性分析 2020 年 3 月至 2021 年3 月柳州市工人医院产检孕妇的临床资料。纳入标准:(1)年龄18 48 岁;(2)于我院常规产检的孕妇;(3)签署知情同意书;(4)未参加其他临床研究。排除标准:(1)合并有肺大疱、气胸或纵隔气肿;(2)血压明显降低(90/60 mmHg，1 mmHg=0.133 kPa);(3)长期使用麻醉药品或其他影响中枢神经系统的药物;(4)急性中耳炎、鼻炎、鼻窦炎感染未控制;(5)青光眼;(6)合并严重心肝肾功能损害、造血系统疾病及精神病患者;(7)随访资料不完整。基于上述纳入、排除标准共纳入孕妇 181 例，年龄22 41(31 4)岁，已分娩且信息完善者156 例。中期妊娠孕妇共99 例，孕周14.1 27.5(21.7 3.9)周;晚期妊娠孕妇共 57 例，孕周28 38.3(31.7 2.7)周。孕期 OSAHS 患病率为26.9%，其中孕中期、孕晚期 OSAHS 患病率分别为24.2%、31.6%。根据病情将孕妇分为 OSAHS 组42 例，年龄22 41(31 4)岁，其中中期妊娠 24 例，晚期妊娠18 例;非 OSAHS 组114 例，年龄24 41(33 4)岁，其中中期妊娠75 例，晚期妊娠 39 例。本研究通过柳州市工人医院医学伦理委员会批准(KY20191065)。1.2OSAHS 的诊断方法及标准本研究主要是通过询问病史，以及应用便携式睡眠监测仪(Sleep Fairy-A7，湖南万脉医疗科技有限公司)对研究对象进行呼吸睡眠障碍筛查来诊断此病。诊断标准5-6:(1)有典型的夜间睡眠打鼾伴呼吸暂停、日间嗜睡 Epworth嗜睡量表(Epworth Sleepiness Scale，ESS)评分9 分等症状，查体发现咽腔狭窄、扁桃体肿大、悬雍垂粗大、腺样体增生，呼吸暂停低通气指数(apnea hypopneaindex，AHI)5 次/h 者可诊断 OSAHS;(2)日间嗜睡不明显(ESS 评分 9 分)者，AHI10 次/h;(3)AHI5 次/h，同时