妊娠合并血小板减少238例临床分析

Cause and therapy of thrombocytopenia in pregnancy.

目的探讨妊娠合并血小板减少症的病因及治疗。方法对238例妊娠合并血小板减少患者的临床资料进行回顾性分析。结果单纯由妊娠引起的血小板减少171例(71.85%),特发性血小板减少性紫癜(ITP)引起20例(8.40%),合并肝脏疾病18例(7.56%),重度妊高征引起25例(10.50%),Rh血型不合及病毒感染各2例(各占0.84%)。对血小板<50×109/L者用强的松治疗,分娩前后使用血小板制剂,同时考虑剖宫产。结论妊娠期血小板减少是最常见的妊娠合并血小板减少症类型。有合并症的血小板减少程度严重,大多<70×109/L,半数ITP有临床症状。糖皮质激素是治疗严重血小板减少的有效手段,术前血小板仍<50×109/L可输注浓缩血小板。

Obiective： To explore the causes and therapy of pregnant women with thrombocytopenia. Metheds： 238 cases with thrombocytopenia were reviewed. Results： Thrombocytopenia was mainly caused by prenacy -associated thrombocytopenia （PAT） in 171 （71.85%） cases, idiopathic thrombocytopenia （ITP） in 20 cases （8.40%）, hepatic disease in pregnancy in 10 （7. 56% ） cases, pregnancy induced hypertension 25 （ 10. 50% ） cases, Rhesus isolmmunization and viral infection each 2 （0. 84% ） case. Prednisone was considered if the platelet count was less than 50 ×10^9/L Platelet transfusion was given to those with platelet count less than 50 ×10^9/L before and after delivery. If the platelet count was less than 50×10^9/L esarean delivery might be performed. Conclusion ： PAT is the most common type of thrombocytopenia during pregnancy. Degree of thrombocytopenia with complication was more severe （platelet count usually less than 70 ×10^9/L）. Half of ITP are symptomatic. Glucocorticoid is effective treatment for severe thrombocytopenia. Platelet transfusion may be considered when platelet count is still less than 50 ×10^9/L before opreation.