妊娠合并血小板减少120例临床分析

Clinical Analysis on 120 Cases of Pregnancy with Thrombopenia

目的探讨妊娠合并血小板减少的病因及围生期处理原则。方法总结1996～2006年本院120例妊娠合并血小板减少患者的临床资料。结果妊娠合并血小板减少的主要原因有：①妊娠期血小板减少症（GT）：②妊娠期高血压疾病；③特发性血小板减少性紫癜（ITP）。治疗原则：①针对病因治疗：②用药时尽可能减少对胎儿的不利影响；③GT组一般不需特殊处理；④血小板〈50×10^9／L，有明显出血倾向时，给予糖皮质激素和／或免疫球蛋白治疗；⑤血小板〈20×10^9／L，或血小板在（20～50）×10^9／L之间，伴有明显出血倾向且在分娩及紧急手术前，建议输注血小板；⑥分娩方式视血小板多少及有无产科手术指征而决定。结论治疗妊娠合并血小板减少应视不同病因及病情轻重的程度而采取不同的处理方式，糖皮质激素、免疫球蛋白及血小板制剂是治疗重度血小板减少的有效方法。

Objective This article intends to probe into the pathogenesis of pregnancy with thrombopenia and discuss the principles of perinatal treatment. Methods Sum up the clinical data involving 120 cases of pregnancy with thrombopenia in this hospital from 1996 to 2006. Results Main causes of pregnancy with thrombopenia are as follows： （1）gestational thrombocytopenia （GT）; （2）pregnancy induced hypertension; （1）idiopathic thrombocytopenic purpura （ITP）. Therapeutic principles： （2）Targeting the pathogenesis; （3）Minimizing disadvantages of drug against embryo; （4）No need of particular treatment for GT group; （5） When the bleeding tendency becomes evident with thrombocyte 〈 50 × 10^9/L, apply Glucocorticoid and/or immune globulin; （5） When the bleeding tendency becomes evident prior to parturition and emergency surgery with thrombocyte 〈20 × 10^9/ L or between （20-50）× 10^9/L, it is advised to infuse thrombocyte; （6） The parturition mode depends on the amount of thrombocyte and obstetrical operation indications. Conclusion Appropriate treatment shall be applied according to the specific pathogenesis, causes and clinical response of pregnancy with thrombopenia. Glucocorticoid, immune globulin and thrombocyte preparation is effective to cure pregnancy with thrombopenia.