目的:探讨妊娠剧吐临床诊治分层管理,以及如何降低严重并发症发生率.方法:纳入陆军军医大学附属第一医院2015年7月至2017年7月重型妊娠剧吐住院患者共21例,回顾性分析其临床特点及临床转归.结果:研究对象均症状重,PUQ评分均>13分;平均年龄30.1±5.2岁,平均住院天数5.95±7.35天;孕前平均体质量指数(BMI) 19.50±2.65 kg/m2,体质量较孕前平均减轻4.65±2.52 kg,16例患者体质量与孕前相比减轻>5%.总尿酮体阳性率为90.5%,其中有10例为尿酮体+++.8例患者并发甲状腺功能亢进.21例患者经积极补液、补充能量、止吐及维持酸碱电解质平衡治疗,18例临床结局满意,3例患者终止妊娠,无一例死亡病例.结论:对于症状重、体重较轻、尿酮体阳性及并发脱水患者建议尽快住院、规范治疗.对重型妊娠剧吐,需及时纠正水电解质紊乱及酸碱失衡预防恶性循环的进展,并辅以适当对症治疗从而减轻症状,提高疗效.
Objective:To explore the clinical management of hyperemesis gravidarum,and the treatment to reduce the incidence of serious complications.Methods:A total of 21 patients were enrolled in Chongqing Southwest Hospital from July 2015 to July 2017,and their clinical features and outcomes were retrospectively analyzed.Results:The subjects were symptomatic and body weight of 16 cases were >5% lower than that before pregnancy.The total positive rate of ketone body was 90.5%,and the urine ketone of 10 cases were 3 +.The concurrent thyroid dysfunction had no effect on the clinical outcome,the difference was not statistically significant(P > 0.05).Of 21 cases of severe hyperemesis gravidarum,18 patients were with satisfactory clinical outcome,3 patients terminated their pregnancy,no one case died.Conclusions:Patients with severe symptoms,weight reduction >5% before pregnancy,urinary ketone positive and concurrent Dehydration were recommended to be hospitalized and get standardized treatment.For the severe hyperemesis gravidarum,we need to promptly improve water and electrolyte disorders and acid-base imbalance to prevent the progress of the vicious cycle,and provide appropriate psychological treatment to alleviate the symptoms and improve efficacy.