妊娠合并慢性肾脏病3~5期患者妊娠中期引产17例临床分析

doi:10.12280/gjfckx.20250044

摘要/Abstract

摘要：

目的：探讨妊娠合并慢性肾脏病（chronic kidney disease，CKD）3~5期患者妊娠中期不同引产方式的安全性及有效性。方法：回顾性选取2019年10月1日—2023年9月30日郑州大学第一附属医院收治的妊娠合并CKD3~5期进行妊娠中期引产的孕妇17例，根据不同引产方式分为依沙吖啶组（乳酸依沙吖啶羊膜腔注射引产，9例）和水囊组（水囊引产，8例），比较2组患者的一般资料、引产效果、引产结局、引产并发症及引产前后的肾功能。结果：2组引产成功率比较，差异无统计学意义（88.9% vs. 100.0%，P =1.000）。2组引产-临产时间、总产程时间、产时出血量、死胎质量及宫内残留发生率比较，差异无统计学意义（均P>0.05）。2组患者均未发生产后出血、会阴裂伤、胎盘早剥、弥散性血管内凝血、宫内感染、子宫破裂、中转剖宫取胎术及产褥感染等并发症。2组引产前后血肌酐、尿素氮、尿酸及肾小球滤过率比较，差异无统计学意义（均P>0.05）。2组合并瘢痕子宫患者的引产成功率比较，差异无统计学意义（P =1.000）。结论：乳酸依沙吖啶和水囊引产两种方法用于妊娠合并CKD3~5期患者妊娠中期引产均安全、有效，且未增加引产并发症的发生风险，但各有利弊，临床工作中需要多学科协作，共同制定适宜的引产方案。

关键词: 妊娠中期, 肾功能不全, 慢性, 引产, 依沙吖啶, 妊娠合并慢性肾脏病, 水囊

Abstract:

Objective: To evaluate the safety and efficacy of different induction methods in pregnant women in the second trimester with chronic kidney disease (CKD) Stages 3-5. Methods: A retrospective study was conducted on 17 pregnant women with CKD Stages 3-5 who underwent midtrimester induction of labor at the First Affiliated Hospital of Zhengzhou University between October 1, 2019 and September 30, 2023. Patients were divided into two groups based on induction method: the ethacridine group (intra-amniotic injection of ethacridine lactate, n=9) and the balloon catheter group (mechanical dilation with a Foley catheter, n=8). General characteristics, induction outcomes (success rate, induction-to-delivery interval, total labor duration), complications, and renal function before and after induction were compared. Results: No significant differences were observed in induction success rate (88.9% vs. 100.0%, P =1.000), induction-to-delivery time, total labor duration, intra-partum blood loss, fetal weight, or incidence of retained products of conception (all P>0.05). Neither group experienced complications such as postpartum hemorrhage, perineal laceration, placental abruption, disseminated intravascular coagulation, intrauterine infection, uterine rupture, conversion to cesarean section, or puerperal infection. Renal function markers (serum creatinine, blood urea nitrogen, uric acid and estimated glomerular filtration rate) remained stable before and after induction in both groups(all P>0.05). For patients with a scarred uterus, success rate did not differ significantly (P =1.000). Conclusions: Both ethacridine lactate and balloon catheter methods are safe and effective for induction of labor in the second trimester in CKD Stages 3-5 patients, without increasing complication risks. However, each method has specific advantages and limitations. Multidisciplinary collaboration is recommended to select individualized induction strategies.

Key words: Pregnancy trimester, second, Renal insufficiency, chronic, Labor, induction, Ethacridine, Pregnancy with chronic kidney disease, Balloon catheter

李灵燕, 赵先兰. 妊娠合并慢性肾脏病3~5期患者妊娠中期引产17例临床分析[J]. 国际妇产科学杂志, 2025, 52(4): 389-393.

LI Ling-yan, ZHAO Xian-lan. Clinical Analysis of 17 Cases of the Second Trimester Induction of Labor in Pregnant Women with Chronic Kidney Disease Stages 3-5[J]. Journal of International Obstetrics and Gynecology, 2025, 52(4): 389-393.

图/表 5

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组别	n	年龄（岁）	孕周（周）	孕次（次）	产次（次）	瘢痕子宫占比
依沙吖啶组	9	33.1±4.5	20.7±3.7	3.00（2.00， 5.00）	1.00（0.50， 1.50）	6（66.7）
水囊组	8	29.0±4.7	19.7±5.2	3.00（1.00， 3.75）	1.50（0.00， 2.75）	3（37.5）
t		1.847	0.451	-	-	-
P		0.085	0.658	1.000^a	0.335^a	0.347^b

组别	n	年龄（岁）	孕周（周）	孕次（次）	产次（次）	瘢痕子宫占比
依沙吖啶组	9	33.1±4.5	20.7±3.7	3.00（2.00， 5.00）	1.00（0.50， 1.50）	6（66.7）
水囊组	8	29.0±4.7	19.7±5.2	3.00（1.00， 3.75）	1.50（0.00， 2.75）	3（37.5）
t		1.847	0.451	-	-	-
P		0.085	0.658	1.000^a	0.335^a	0.347^b

组别	n	肌酐（μmol/L）	尿素氮（mmol/L）	尿酸（μmol/L）	肾小球滤过率 [ mL/（min·1.73 m²）]
依沙吖啶组	9	264.2±103.2	15.8±6.9	475.1±102.3	23.1±7.9
水囊组	8	338.9±185.5	17.5±7.9	448.1±119.8	22.6±15.5
t		1.008	0.464	0.501	0.083
P		0.336	0.650	0.624	0.936

组别	n	肌酐（μmol/L）	尿素氮（mmol/L）	尿酸（μmol/L）	肾小球滤过率 [ mL/（min·1.73 m²）]
依沙吖啶组	9	264.2±103.2	15.8±6.9	475.1±102.3	23.1±7.9
水囊组	8	338.9±185.5	17.5±7.9	448.1±119.8	22.6±15.5
t		1.008	0.464	0.501	0.083
P		0.336	0.650	0.624	0.936

组别	n	引产-临产时间（h）	总产程时间（h）	产时出血量（mL）	死胎质量（g）	宫内残留
依沙吖啶组	8^#	19.4±6.6	4.4±1.2	100（100，150）	340.0±195.1	4（50.0）
水囊组	8	30.0±23.9	4.0±1.2	100（100，150）	326.3±254.7	4（50.0）
t		1.204	0.652	-	0.121	-
P		0.263	0.525	1.000^a	0.905	1.000^b