作者：杨培学，彭坤，陆丽红，胡俊喜
【摘要】目的：探讨妊高征终止与继续妊娠的眼底改变。方法： 将260例妊高征眼底改变分为终止妊娠组与继续妊娠组均对眼底改变进行回顾分析。终止妊娠组：130例260眼，孕周期在28~40周，年龄22~38岁，血压控制在140/90 mm Hg以下，给予剖腹产或引产。继续妊娠组给予降血压药物及保胎药物应用。随访3~6个月，将每组均产后眼底变化进行了比较分析。 结果：终止妊娠组：眼底视网膜病变明显恢复，视力明显提高，并发症较少。继续妊娠组：眼底视网膜病变，出血、渗出、视网膜脱离、玻璃体积血、恢复较慢、视力提高不明显，并发症较多。两组眼底的改变及视力的影响相比均有显著差异。 结论：妊高征一旦出现眼底的改变应立即终止妊娠，减少眼底视网膜病变及并发症的发生，从而使视力恢复正常。
【关键词 】 妊高征；眼底改变；终止妊娠；继续妊娠
The study of fundus changes of regnancy induced hypertension between terminated gestation and continued
Yang Pei-xue，Peng Kun，Lu Li-hong，et al
(The First Teaching Hospital of Xin Xiang Medical College. Wei Hui，453100)
【Abstract】Objective：To observe the fundus changes of regnancy induced hypertension between terminated gestation and continued gestation. Methods:The fundus changes of 130 patients (260eyes)with regnancy induced hypertension(divided into two groups: terminated gestation group and continued gestation group)were retrospectively analyzed.The terminated gestation group: 130patients,260 eyes,22~38 years old. Blood pressure was controlled under 140/90 mmhg.The patients were given caesarean birth or derivation birth.The continued gestation group: The patients were given medicaments to reduce blood pressure and protect embryo.All patients had been followed up from 3 to 6 months.The fundus changes were Studied after gestation.Results: The terminated gestation group: the pathological changes of retina was ameliorated in evidence. The vision was increased in evidence. There was few syndrome;The continued gestation group: There were many syndromes,such as bleeding、effusion、disengage and so on. The vision was not increased in evidence . There were markedly difference between two groups.Conclusions: When the fundus changes appered in regnancy induced hypertension, the terminated gestation can reduce the fundus changes and increase the vision.
【Key words】Regnancy induced hypertension； Fundus change； Terminated gestation； Continued gestation
妊娠高血压综合征（妊高征）是一种严重妇产科并发症，其主要临床特征为高血压、水肿、蛋白尿、先兆子痫、常合并眼底改变及视力下降。我科专业人员专门检查妊高征眼底的改变及视力的变化，进行比较分析如下。
1临床资料
1.1一般资料收集自1990年2月-2005年2月，我科收治了妊高征继续妊娠产后眼底视网膜病变合并视网膜脱离玻璃体积血共130例260眼。依据《妇产科学》（第六版） ［1］分为妊高征血压子痫前期又分为轻度、中度、子痫。除外慢性高血压及肾病合并妊高征。均属于重度妊高征的患者在8个月后出现妊娠征、血压在160/110 mm Hg以上，均为初产妇，平均年龄（25±3.2）岁，平均孕周（36.2±3.1）周。尿蛋白（++++），出现头晕、头痛、视觉障碍、上腹不适、胸闷及恶心呕吐，部分患者抽搐。
1.2方法眼底检查：妊高征的孕妇均入院后24 h内常用直接检眼镜检查，检查前用0.5%托品卡胺眼液点眼扩瞳后检查眼底。眼底视网膜病变分为III期［2］，Ⅰ期：动脉痉挛期，视网膜小动脉功能性痉挛和狭窄，可局限于一枝或整个眼底动脉缩窄，动静脉管径的比例由正常2∶3变为1∶3；Ⅱ期：动脉硬化期，由于血压持续升高，血管从功能性收缩进入到器质性硬化；Ⅲ期：视网膜病变期，视网膜水肿、出血、棉絮状渗出。
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