妊娠期高血压疾病并发HELLP综合征终止妊娠时机探讨  

Study on the Time and Method of Pregnant Termination in Hypertension Disorder Complicating Pregnancy with HELLP Syndrome

作　　者：冯碧波[1] 陈敏秀[1] 蔡昱[1] 翟建军[1] 

机构地区：[1]首都医科大学附属北京同仁医院妇产科,北京市100730

出　　处：《中国动脉硬化杂志》2010年第11期906-908,共3页Chinese Journal of Arteriosclerosis

摘　　要：目的探讨妊娠期高血压疾病并发溶血、肝酶升高、血小板减少综合征(HELLP综合征)患者终止妊娠时机及方式对母儿结局的影响。方法回顾分析47例HELLP综合征患者的临床资料,按确诊至终止妊娠时间分两组:48 h内终止妊娠组29例,在确诊后48 h内终止妊娠;48 h后终止妊娠组18例,在确诊后48 h后终止妊娠。比较两组孕产妇严重并发症及围生儿结局。结果 48 h后终止妊娠组孕产妇并发胎盘早剥、急性肾功能衰竭、心功能衰竭和弥漫性血管内凝血发生率(分别为38.9%、33.3%、27.8%和27.8%)明显高于48 h内终止妊娠组(分别为10.4%、6.9%、3.5%和3.5%;P<0.05)。48 h内终止妊娠组与48 h后终止妊娠组新生儿呼吸窘迫综合征、新生儿窒息及围生儿死亡发生率(10.4%比33.3%、10.4%比44.4%、10.4%比33.3%)比较,差异有显著性意义(P<0.05)。47例中,仅6例阴道分娩。结论 HELLP综合征严重威胁母儿安危,应根据母儿情况,严格选择保守病例,建议在确诊后48 h内首选剖宫产终止妊娠。Aim To investigate the optimal time and mode of termination of pregnancy for patients with hemolysis,elevated liver enzymes and low platelet syndrome（HELLP syndrome）. Methods The data of 47 cases with HELLP syndrome were retrospectively analyzed.According to the length from the diagnosis-confirmed time to the time of delivery,the patients were divided into 2 groups： groupⅠwith 48 hours,groupⅡover 48 hours.The blood test,clinical presentations,maternal-neonatal complications and outcomes were compared between the two groups. Results The incidence of placental abruption,acute renal failure,heart failure,DIC was 38.9%,33.3%,27.8%,27.8% respectively in groupⅡ,significantly higher than those in groupⅠ（P0.05）,significant difference was found in neonatal respiratory distress syndrome（NRDS）,neonatal asphyxia and perinatal mortality rate between the two groups（10.4% vs 33.3%,10.4% vs 44.4%,10.4% vs 33.3%（P0.05）. Conclusion HELLP syndrome is serious to both mother and fetus.The cases for expectant treatment should be strictly selected based on the conditions of mothers and fetus.Cesarean section is the first choice in 48 h after diagnosis.

关 键 词：妊娠期高血压疾病 HELLP综合征 分娩时机 分娩方式 

分 类 号：R711[医药卫生—妇产科学]