妊娠期高血压疾病的临床分级管理
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李媛媛
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湖北省襄阳市谷城县人民医院妇产科，湖北襄阳，441700
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摘要：妊娠期高血压疾病（hypertensive disorders of pregnancy, HDP）是妊娠中晚期常见的严重并发症，以高血压、蛋白尿及多器官功能损害为主要特征，是导致孕产妇和围产儿死亡的重要原因之一。目的 深入探讨妊娠期高血压疾病（HDP）临床分级管理模式在基层医疗机构的适用性及母婴结局改善效果。方法 采用回顾性队列研究设计，分析纳入2023年1月—2024年6月某基层医院收治的200例HDP 患者，根据《妊娠期高血压疾病诊治指南》进行精准分级，分为妊娠期高血压（56 例）、轻度子痫前期（78 例）、重度子痫前期（66 例），采用结构化分级管理模式（包括风险分层、动态血压监测、对症解痉降压、适时终止妊娠等），对比三组母婴并发症发生率及管理前后子痫发生率的差异，比较母婴结局。结果 重度子痫前期组剖宫产率（84.8%）、新生儿窒息率（19.7%）显著高于妊娠期高血压组（21.4%、3.6%）和轻度子痫前期组（42.3%、7.7%）（P＜ 0.01）。分级管理后，重度子痫前期患者子痫发生率由历史数据的12.5%降至3.0%。结论 临床分级管理通过资源优化配置和差异化干预，显著降低重度子痫患者及新生儿窒息风险，可优化HDP 患者母婴结局，是基层医院提升妊娠期高血压疾病管理效能的科学路径，适合基层医院推广。
关健词：妊娠期高血压疾病；临床分级管理；母婴结局；子痫前期；基层医院
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Clinical Grading Management of Hypertensive Disorders in Pregnancy
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Yuanyuan Li
Obstetrics and Gynecology Department of Gucheng County People’s Hospital, Xiangyang, Hubei 441700 , China
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Abstract：Hypertensive disorders complicating pregnancy are common severe complications in the middle and late stages ofpregnancy, characterized by hypertension proteinuria, and multi-organ dysfunction, and are one of the important causes of maternaland perinatal deaths. Objective To further explore the applicability of the clinical management model of hypertensivedisorders complicating pregnancy (HDP) in primary medical institutions and the effect of improving maternal and infant outcomes.Methods A retrospective cohort study design was to analyze 200 cases of HDP patients admitted to a primary hospitalfrom January 2023 to June 2024. According to the“ Gu for the Diagnosis and Treatment of Hypertensive Disorders ComplicatingPregnancy”, the patients were accurately graded into gestational hypertension (56 cases), preeclampsia (78 cases), and severepreeclampsia (66 cases). A structured graded management model (including risk stratification, dynamic pressure monitoring,symptomatic spasmolysis and blood pressure reduction, and timely termination of pregnancy, etc.) was used to compare the incidenceof maternal and infant complications and the of eclampsia incidence before and after management among the three groups,and to compare maternal and infant outcomes. Results The rate of cesarean section (848%) and the rate of neonatal asphyxia(19.7%) in the severe preeclampsia group were significantly higher than those in the gestational hypertension (21.4%, 3.6%) andthe mild preeclampsia group (42.3%, 7.7%) (P<.01). After graded management, the incidence of eclampsia in severe preeclampsiapatients was reduced from 12.5% in the historical to 3.0%. Conclusion Clinical graded management has significantly reducedthe risk of severe preeclampsia patients and neonatal asphyxia through resource optimization and intervention, which canoptimize the maternal and infant outcomes of HDP patients, which is a scientific path to improve the management efficiency ofhypertensive disorders complicating pregnancy in primary hospitals, is suitable for the promotion of primary hospitals.
Keywords : gestational hypertension disease; Clinical grading management; Maternal and infant outcomes; Preeclampsia; primary-level hospital
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