探讨子痫前期(PE)患者胎盘血管结构的临床意义，以及低剂量肠溶阿司匹林、硝苯地平和沙丁胺醇三联药物，对改善其胎盘灌注功能的作用。

选择2006年8月至2013年8月在济南军区总医院住院分娩的158例PE患者为研究对象。按照分娩时药物应用情况，将其分为MgSO₄组(n＝54，采用MgSO₄解痉)，硝苯地平组(n＝48，采用硝苯地平治疗)，三联组(n＝56，联合采用低剂量肠溶阿司匹林、沙丁胺醇和硝苯地平治疗)。选择同期于同一家医院住院分娩的86例正常、足月孕妇纳入正常组。采用改良胎盘血管铸型技术，对4组受试者胎盘铸型，并分析其特点。应用流式细胞术测定4组受试者红细胞内Ca^2＋(IECa^2＋)水平，并统计学分析其产前、产时及产后第5天IECa^2＋水平变化。统计学分析MgSO₄组、硝苯地平组和三联组中，轻度、重度PE患者分娩新生儿轻、重度窒息，胎儿宫内生长受限(FGR)及死胎发生率。MgSO₄组、硝苯地平组、三联组及正常组受试者年龄、分娩孕龄等一般临床资料比较，差异均无统计学意义(P>0.05)。

①成功制作正常组受试者与PE患者胎盘血管标本，并各具有其特点。MgSO₄组、硝苯地平组及三联组重度PE患者胎盘血管容积为(102.8±46.1) mL，显著小于正常组的(152.5±55.3) mL，二者比较，差异有统计学意义(t＝2.707，P<0.01)。②正常组孕妇产前及产时IECa^2＋水平分别为(1 101.7±89.2)FC和(1 173.5±86.2)FC，二者比较，差异有统计学意义(t＝2.843，P<0.01)。MgSO₄组、硝苯地平组及三联组中重度PE患者产前、产时及产后第5天IECa^2＋水平较正常组相同时间点的IECa^2＋水平均显著增加，且差异均有统计学意义(t＝2.118，2.134，2.003；2.140，2.079，2.083；2.721，2.109，2.152；P<0.05)。③三联组重度PE患者分娩新生儿轻、重度窒息，FGR和死胎发生率均显著低于MgSO₄组，差异均有统计学意义(χ²＝64.10，67.21，65.31，69.10；P<0.05)，与硝苯地平组比较，差异均无统计学意义(P＝0.636，0.563，0.336，0.417)。

胎盘血管三维铸型对于研究胎盘功能具有重要价值，也为临床教学提供直观模型。低剂量肠溶阿司匹林、硝苯地平和沙丁胺醇三联药物治疗PE患者，具有协同降低其IECa^2＋水平与改善PE胎盘灌注功能作用。

To investigate clinic significance of vascular casting of three-dimensional structure in human normal pregnancy and preeclampsia (PE) placental, and effect of improvement of its blood-priming function with treatment by trigeminy drugs as aspirin, nifedipine and salbutamol.

From August 2006 to August 2013, a total of 158 cases of pregnant women with PE were chosen as study subjects. According to their treatment strategies during delivery, they were divided into MgSO₄ group (n=54, antispasmodic treatment by MgSO₄), nifedipine group (n=48, treatment by nifedipine) and trigeminy drugs group (n=56, treatment by trigeminy drugs as aspirin, nifedipine and salbutamol). During the same period and in the same hospital, a total of 86 cases of normal and full-term pregnant women were included into normal group. Modified method of cast of placenta vascular was performed to cast placental vascular in 4 groups and their characteristics were analyzed. Intra erythrocyte Ca²⁺ (IECa²⁺ ) levels among 4 groups were measured and incidence of neonatal mild, severe asphyxia, fetal intrauterine growth restriction (FGR), and stillbirth among mild, severe PE pregnant women were analyzed by statistical methods. There were no significat differences among 4 groups in age, gestational age at delivery etc. (P>0.05).

①The three dimensional structure in human placentas with normal and PE pregnancy were revealed. The volume of placental vascular bed in sever PE was statistically less than that in normal group [(102.8±46.1) mL vs (152.5±55.3) mL], and there was significance difference (t=2.707, P<0.01). ②IECa²⁺ levels in normal group were (1 101.7±89.2) FC before deliver stage, and (1 173.5±86.2) FC during deliver stage, and the difference was statistically different (t=2.843, P<0.01). However the IECa²⁺ levels of ones with sever PE in MgSO₄ group, nifedipine group and trigeminy drugs group showed statistically higher than those in normal group before, during and after deliver stage, respectively (t=2.118, 2.134, 2.003; 2.140, 2.079, 2.083; 2.721, 2.109, 2.152; P<0.05). ③The incidences of mild and sever asphyxia, FGR and stillbirth of neonatals of sever PE in trigeminy drugs group were all statistically lower than those in MgSO₄ group, and the differences were statistically different (χ²=64.10, 67.21, 65.31, 69.10; P<0.05), and slightly lower than those in nifedipine group, while the differences were not statistically different (P=0.636, 0.563, 0.336, 0.417).

The human placental vascular casts constructed in this study provide a valuable tool for understanding the structures of uteroplacental vasculatures. They can be used as models for visualizing placental structures and investigating placental functions in diseases such as PE. The level of IECa²⁺ can reflect the degree of asphyxia. Treatment by trigeminy drugs as aspirin, nifedipine and salbutamol has an important effect for improving outcomes of newborns by increasing the placenta blood-giving function.