HELLP综合征15例临床分析  

Clinical Study on 15 Cases of HELLP Syndrome

作　　者：毛圆圆[1] 陈友国[1] 黄亚珍[1] 张跃明[1] 杨丽菊[1] 杨伟文[1] 

机构地区：[1]苏州大学附属第一医院,江苏苏州215006

出　　处：《实用妇产科杂志》2010年第6期459-462,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:通过对HELLP综合征患者的临床经过及死因进行分析,以探讨更好的诊治方法。方法:对我院6年中诊断为HELLP综合征的15例患者的临床经过、实验室检查、并发症和母儿结局进行回顾性分析。结果:15例患者平均发病孕周35.31±3周,完全性HELLP综合征12例(其中2例为产后发展为HELLP),部分性HELLP综合征3例。全部有肝酶升高(45～580U/L)和血小板减少(6～74×109/L)。孕产妇并发症:腹水、肾功能衰竭、胎盘早剥、DIC、脑部病变、子痫、产后出血,1例继发血栓性血小板减少性紫癜。15例患者均接受血浆及常规激素治疗,其中2例另接受血浆置换,1例并发急性呼吸窘迫综合征(ARDS)。母亲死亡2例(13.33%)(脑疝、ARDS各1例),围生儿死亡4例(26.67%,新生儿死亡、死产各1例,死胎2例)。结论:重视重度子痫前期的管理和治疗,早期发现HELLP综合征、大剂量激素应用,24～48小时后终止妊娠,动态观察产后72小时的实验室指标和临床变化,避免过度输液,可望改善母儿预后。Objective：To investigate the better diagnosis and management through analyzing the clinical course and death cause of HELLP （hemolysis, elevated liver enzymes, and low platelets） syndrome. Methode：The clinical courses, laboratory findings, complications and outcomes of mother and fetus in 15 cases with HELLP syndrome were retrospectively reviewed during the past 6 years in our hospital. Results：The mean gestational age at delivery was 35.31 ±3 weeks. There were 12 cases of complete HELLP syndrome （2 occurred postpartum） and 3 cases of incomplete. All cases had elevated liver enzymes（45 -580 U/L） ,and thrombocytopenia （6 - 74 × 10 9/L）. The matemal complications included ascites, renal failure,placental abruption, DIC, cerebral changes, eclampsia, postpartum hemorrhage, and one case occurred secondary thrombotic thrombocytopenic purpura （TTP）. All of them were given fresh frozen plasma and dexamethasone. Among them, two cases received extra plasma exchange, and one of them complicated with adult respiratory distress syndrome （ARDS）. Two mothers were dead （13.33%） （1 was hernia of brain, 1 was ARDS）. Perinatal mortality rate was 26.67% （1 was neonatal death, 1 was stillbirth, 2 were fetal death）. Conclusions：We emphasize to enhance the management and treatment of severe preclampsia, early diagnosis of HELLP syndrome, using large dosage of dexamethasone, and termination of the pregnancy within 24 - 48 hours. Avoiding overtransfusion and closely observing the laboratory findings and clinical changes within 72 hours after delivery, the prognosis of the mother and fetus can be improved.

关 键 词：HELLP综合征 子痫前期 血浆置换 

分 类 号：R714.244[医药卫生—妇产科学]