重度子痫前期合并HELLP综合征18例临床分析

Clinical Analysis of 14 Cases of Severe Preeclampsia with HELLP Syndrome

目的探讨产科并发症HELLP综合征的母儿预后。方法回顾性分析研究18例HELLP综合征的患者妊娠结局和围生儿预后。结果18例中14例发生在产前,4例发生在产后,平均孕龄为(34+3±4+1)周,孕妇的严重并发症包括急性肾功能衰竭、DIC、肺水肿、严重腹水和胎盘早剥等。其中12例需要输血或血液制品,17例采用剖宫产结束分娩。围生儿死亡7例,主要与胎盘早剥有关,另外胎儿宫内窘迫及早产也是重要原因。结论HELLP综合征是一种严重的产科并发症,其高的母婴并发症和病死率要求我们对有妊娠高血压疾病的患者进行密切随访和治疗,一旦确诊为HELLP综合征应转入中心级以上医院进行治疗,尽快终止妊娠。

Objective To investigate the maternal and perinatal outcomes of pregnancies complicated with HELLP syndrome. Methods Fourteen cases of HELLP syndrome were retrospectively analyzed on maternal and perinatal outcomes. Results In 18 case of women with HELLP syndrome, 14 presented antepartum HELLP and 4 postpartum. Mean gestational age at delivery was （34^＋3±4^＋1） weeks. Severe maternal complications included acute renal failure, disseminated intravascular coagulation, abrnption placenta, pulmonary edema and severe ascites, et al. 12 patients required transfusions with blood or blood products and 17women underwent cesarean section. Seven perinatal deaths were related to abrnption placenta, intrauterine asphyxia and extremepremature delivery. Conclusions HELLP syndrome is a severe obstetric complication. The high maternal and perinatal mortality and morbidity of mother and baby requires close maternal-fatal surveillance and timely management. Once the diagnosis was made, the patients should be sent to the central hospital and termination of the pregnancy as soon as possible would be helpful for the prognosis.