妊娠期血小板减少的相关性及围产结局分析  

The main etiologic factors and the outcome for pregnancy women complicated with thrombocytopenia

作　　者：岳军[1] 梅立[1] 陈廉[1] 

机构地区：[1]四川省医学科学院.四川省人民医院妇产科,四川成都610072

出　　处：《西部医学》2011年第11期2117-2119,2122,共4页Medical Journal of West China

摘　　要：目的探讨妊娠期血小板减少的原因及围产结局。方法回顾性分析我院2003年1月～2010年5月154例妊娠期血小板减少患者的临床资料。结果 154例患者中妊娠相关性血小板减少(GT)87例(56.5%),妊娠期高血压疾病(PIH)25例(16.2%),妊娠期肝内胆汁淤积症(ICP)23例(14.9%),特发性血小板减少性紫癜(ITP)12例(7.8%),其他病因7例(4.5%)。有出血倾向或血小板计数≥50×109/L患者需用糖皮质激素和(或)免疫球蛋白治疗,阴道分娩31例,剖宫产104例,产后出血6例。GT、PIH和ICP组患者产后42天血小板较产前差异均有显著性(P<0.05),ITP组患者产后42天血小板较产前无显著性差异(P>0.05)。结论妊娠期血小板减少的不同病因中,以妊娠相关性血小板减少最多见。对血小板<50×109/L或有明显出血倾向者,用糖皮质激素和(或)免疫球蛋白治疗。分娩前后使用血小板制剂,预防产时或产后出血。血小板≥50×109/L,应在术前输注浓缩血小板后行剖宫产,血小板计数≥50×109/L的孕妇,如无产科指征,应阴道分娩为主,GT一般不作特殊处理。Objective To explore the etiopathogenesis and the optimal management in pregnant women complicated with thrombocytopenia1.Methods 154 cases of pregnant women complicated with thrombocytopenia were retrospectively studied.Results There were 87 cases（56.5%）,25 cases（16.2%）,23 cases（14.9%） and 12 cases（7.8%） induced by gestation-associated thrombocytopenia（GT）,pregnancy induced hypertension（PIH）,intrahepatic cholestasis of pregnancy（ICP） and idiopathic thrombocytopenia（ITP）,respectively.Vaginal delivery and cesarean section were performed in 38 and 97cases.The platelet count of GT patients and PIH patients were different after delivery（P0.05）.Conclusion The reasons caused thrombocytopenia during pregnancy are diverse.GT is the most common type.Glucocorticoid and（or） immuning global protein are given to those with platelet count less than 50×109/L.Platelet transfusion may be considered before or after delivery to prevent hemorrhage when platelet count is still less than 50×109/L.Caesarean delivery should be performed after infusion of platelet concentrate in those platelet 50×109/L.In patients whose platelet50×109/L,transvaginal delivery can be chosen if there is no obstetrical indication.

关 键 词：妊娠 血小板减少 治疗 

分 类 号：R558.2[医药卫生—血液循环系统疾病]