抢救1例HELLP综合征并发肝包膜下血肿、破裂出血休克的报道  

Rescuing a pregnant woman with HELLP syndrome complicated with hepatic subcapsular hematoma and rupture hemorrhagic shock:a case report

作　　者：黄春艳 程秋蓉 周双 HUANG Chun-yan;CHENG Qiu-rong;ZHOU Shuang(Department of Obstetrics,People′s Hospital of Xiangxi Autonomous Prefecture,Hu′nan Province,Jishou416000,China;Jishou University School of Medicine,Hu′nan Province,Jishou416000,China)

机构地区：[1]湖南省湘西自治州人民医院产科,湖南吉首416000 [2]吉首大学医学院,湖南吉首416000

出　　处：《中国当代医药》2020年第18期209-212,共4页China Modern Medicine

摘　　要：HELLP综合征是重度子痫前期的严重并发症之一,并发肝包膜破裂出血是一种罕见的产科危急重症,病情变化快速、凶险,严重威胁母儿健康,临床表现复杂,严重考验临床医生的临床思维及快速反应能力.目前临床医师对该病认识不足,缺乏临床经验,在及时处理及药物选择上经验不足.而全面的母体状况整体评估和病因鉴别,尽早诊断,及时处理,多学科联合抢救,是降低母儿病率和死亡率的关键.本文报道1例多科联合抢救成功的HELLP综合征并发肝包膜破裂出血休克的孕妇,该孕妇入院后行急诊超声检查,快速启动绿色通道与肝胆外科同时上台剖宫产和肝动脉结扎、肝创面压迫止血、术后转ICU抢救等经过2个多月的多学科的救治,患者痊愈出院.通过对该例孕妇症状、体查、临床检查结果、病史及诊治经过的综合全面分析,旨在总结救治体会及经验教训,以提高产科团队快速反应能力、快速准确评估病情变化及综合救治水平.HELLP syndrome is one of the serious complications of severe preeclampsia,complicated with hepatic capsular rupture and hemorrhage,which is a rare critical and severe obstetric disease.The disease changes rapidly and dangerously,which seriously threatens the health of mother and child.Its complex clinical manifestation poses a great challenge for clinical thinking and rapid response ability of clinicians.At present,clinicians have insufficient understanding of this disease,lack of clinical experience,especially in timely treatment and drug selection.However,comprehensive assessment of maternal condition,etiology identification,early diagnosis,timely treatment and multidisciplinary treatment are the keys to reducing the morbidity and mortality of gravida and fetus.This article reports a case of a successful multidisciplinary rescue of a pregnant woman with HELLP syndrome complicated with hepatic rupture and hemorrhagic shock.After admission,this pregnant woman underwent emergency ultrasound examination,quickly started green channel and hepatobiliary surgery to perform cesarean section,together with hepatic artery ligation,hepatic wound compression,hemostasis and ICU rescue after operation.After more than 2 months of multidisciplinary treatment,the patient recovered and was discharged from hospital.Through the comprehensive analysis of the symptoms,physical examination,clinical examination results,medical history,diagnosis and treatment process of the pregnant woman,the purpose is to summarize the treatment experience and lessons,so as to improve the rapid response ability of the obstetrics team,rapid and accurate assessment of disease changes and comprehensive treatment level.

关 键 词：HELLP综合征 肝包膜破裂出血 快速反应 多学科合作 

分 类 号：R714.246[医药卫生—妇产科学]