妊娠期急性脂肪肝的早期诊断及治疗

Early diagnosis and management of acute fatty liver of pregnancy

目的：探讨妊娠期急性脂肪肝的早期诊断及治疗。方法：对我院近6年收治的10例妊娠期急性脂肪肝临床资料进行回顾性分析。结果：10例均发生于妊娠晚期，初产妇8例，经产妇2例；均有恶心、呕吐、厌食、进行性皮肤黄疸及尿色发黄，血清总胆红素明显升高、转氨酶轻中度升高、肝炎病毒血清学阴性。血压升高7例、凝血功能异常8例、血糖降低4例。8例经肝脏超声证实、1例经肝穿刺证实为AFLP。9例于入院后3～7h行剖宫产术，其中同时行子宫切除1例，阴道分娩1例。治愈8例，死亡2例；新生儿正常6例，新生儿窒息3例，死亡2例。结论：早期诊断、尽快行剖宫产术终止妊娠是改善母儿预后的关键；病情严重者同时行子宫切除术；多学科协作、综合治疗、积极输注凝血物质，必要时人工肝替代治疗，能有效提高孕妇的生存率。

Objective： To explore the early diagnosis and management of acute fatty liver of pregnancy （AFLP） . Methods： The clinical findings and outcome of pregnancy were analyzed in 10 patients with AFLP at this hospital in recent 6 years. Results： 10 AFLP manifested in advanced pregnancy, 8 of them were nulliparas and 2 of them were muhiparas; the symptoms included nausea, vomiting, anorexia, progressive jaundice, hyperbilirubinemia, moderately elevated liver transaminase, but negative serum hepatitis virus in each patient. There was hypertension in 7 women, the blood coagulation dysfunction in 8 women, lower blood glucose levels in 4 women. 8 were diagnosed with sonarography and 1 with liver puncture. 9 patients ended the pregnancy with cesarean section, 1 of them with hysterectomy at the same time and 1 vaginal delivery. 8 patients were cured and 2 was dead. 6 of newborns were normal. There were 3 cases of asphyxia and 2 deaths in newborns. Conclusion： The key point to increase the cure of both mother and fetus is to make early diagnosis and end the pregnancy timely with cesarean section. Hysterectomy is essential for severe cases. Transfusions with variable amounts of fresh - frozen plasma, cryoprecipi- tate, et al. with the help of multiple departments and the artificial liver support system are efficient when necessary.