子痫并发HELLP综合征20例患者的临床特点及母婴结局  

Clinical characteristics and maternal-infant outcomes of 20 cases of eclampsia complicated with HELLP syndrome

作　　者：吴金珊 李雅男[1] WU Jin-shan;LI Ya-nan(Department of Obstetrics and Gynecology,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院妇产科

出　　处：《中国实用医药》2019年第32期3-5,共3页China Practical Medicine

摘　　要：目的探讨子痫并发溶血、肝酶升高及血小板减少(HELLP)综合征的临床特点及其对母婴结局的影响。方法70例子痫患者,根据子痫有无并发HELLP综合征分为并发HELLP组(20例)和未并发HELLP组(50例)。观察比较两组患者生化指标[24 h尿蛋白测定、白细胞(WBC)、血红蛋白(Hb)、血小板(PLT)、白蛋白(ALB)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、乳酸脱氢酶(LDH)]及妊娠结局[产后出血、转入重症监护室(ICU)、辅助呼吸支持、合并大脑后部可逆性脑病综合征(PRES)、孕妇死亡、新生儿窒息]。结果并发HELLP组患者AST、ALT及LDH水平分别为(337±361)、(489±500)、(1166±910)U/L,均高于未并发HELLP组的(24±21)、(44±24)、(309±130)g/L,PLT水平(69±36)×109/L低于未并发HELLP组的(188±100)×109/L,差异有统计学意义(P<0.05)。两组患者24 h尿蛋白测定、WBC、Hb、ALB比较,差异无统计学意义(P>0.05)。并发HELLP组患者的转入ICU率、辅助呼吸支持率、合并PRES率及新生儿窒息率分别为90%、80%、80%、70%,均高于未并发HELLP组的52%、44%、42%、42%,差异有统计学意义(P<0.05)。并发HELLP组产后出血率15%高于未并发HELLP组的6%,但差异无统计学意义(P>0.05)。并发HELLP组死亡率为15%高于未并发HELLP组的2%,但差异无统计学意义(P>0.05)。结论子痫并发HELLP综合征病情危重,临床上应加强孕产妇管理,做到早期识别并给予及时有效的治疗,以改善母婴的预后。Objective To discuss the clinical characteristics of eclampsia complicated with emolysis, elevated serum level of liver enzymes, and low platelets(HELLP) syndrome and its influence on maternal-infant outcomes. Methods A total of 70 eclampsia patients were divided into HELLP group(20 cases) and nonHELLP group(50 cases) according to the presence or absence of HELLP syndrome. Observation and comparison were made on biochemical indexes [24 h urine protein determination, white blood cells(WBC), hemoglobin(Hb), platelet(PLT), albumin(ALB), aspartate transaminase(AST), alanine aminotransferase(ALT), lactate dehydrogenase(LDH)] and pregnancy outcomes [postpartum hemorrhage, transfer to intensive care unit(ICU), assisted respiratory support, combined with posterior reversible encephalopathy syndrome(PRES), maternal death, neonatal asphyxia] between the two groups. Results The levels of AST, ALT and LDH were(337±361),(489±500) and(1166±910) U/L in HELLP group, which was higher than(24±21),(44±24) and(309±130) U/L in non-HELLP group, and PLT level(69±36)×10~9/L was lower than(188±100)×10~9/L in non-HELLP group. Their difference was statistically significant(P<0.05). There was no statistically significant difference in 24 h urine protein determination, WBC, Hb and ALB between the two groups(P>0.05). The rate of transfer to ICU, assisted respiratory support, combined with PRES, and neonatal asphyxia were 90%, 80%, 80% and 70% in HELLP group, which were all higher than 52%, 44%, 42% and 42% in non-HELLP group, and their difference was statistically significant(P<0.05). The incidence of postpartum hemorrhage 15% in HELLP group was higher than 6% in nonHELLP group, but the difference was statistically significant(P>0.05). The death rate was 15% in HELLP group, which was higher than 2% in non-HELLP group, but the difference was not statistically significant(P>0.05). Conclusion The eclampsia complicated with HELLP syndrome is critically ill, and the management of maternal patients should be strengthened clinically to ach

关 键 词：子痫 溶血、肝酶升高及血小板减少综合征 母婴结局 

分 类 号：R71[医药卫生—妇产科学]