妊娠合并血小板减少症387例临床分析

Clinical analysis of 387 cases of pregnancy with thrombocytopenia

目的探讨妊娠合并血小板减少症的临床治疗。方法回顾性分析该院1995年1月～2004年12月间妊娠合并血小板减少患者的临床资料,根据血小板情况分为四组,妊娠期发现血小板减少患者给予氨肽素、止血敏、糖皮质激素、丙种球蛋白、输入血小板等治疗。结果阴道分娩112例(29%),剖宫产分娩275例(71%),两种分娩方式产后出血发生率为8%、5%,差异无显著性(χ2=1.084,P>0.05)。血小板>30×109/L时,剖宫产出血量明显多于经阴道分娩(P<0.05),血小板<30×109/L时,两种分娩方式出血量差异无显著性(P>0.1)。407例新生儿(20例为双胎)无颅内出血及其他出血症状,无围产儿死亡发生。结论妊娠合并血小板减少症注意观察及给予相应治疗,产前适当提高血小板水平,选择适当的分娩方式,可以减少产后出血。

[Objective] To investigate the clinical therapy of pregnancy with thromboeytopenia. [Methods] The clinical data of 387 cases of pregnancy with thrombocytopenia in our hospital from Jan.1995 to Dec.2004 were retrospectively analysed. They were divided into 4 groups with the platelets counts. They were treated differently because of the counts of the platelets before the delivery, by using ampeptide elemente, etamsylate, glueoeortieoids, gamma globulin and transfusion of platelets etc. [Results] There were 112 cases of vaginal delivery（29%） and 275 cases of cesarean section（71%）. The rates of postpartum hemorrhage for vaginal delivery and cesarean section patients were 8% and 5% respectively. The difference was unobvious （X^2=1.084, P 〉0.05）. When the platelets counts 〉30×10^9/L, the quantity of hemorrhage for cesarean section was obviously more than for vaginal delivery （P 〈0,05）; when the platelets counts 〈30×10^9/L, there was no obvious difference between them （P 〉0.1）. There were no encephalic hemorrhage case and bleeding symptom in 407 newborns. There was no infantile death. [Conclusion] The pregnancy with thromboeytopenia should be observed and receive therapy. Increasing the platelets counts before delivery and choosing aptitude delivery method can decrease the postpartum hemorrhage.