妊娠期高血压疾病子痫前期合并HELLP综合征的临床分析

Clinical analysis of preeclampsia complicated with HELLP syndrome

目的探讨妊娠期高血压疾病子痫前期合并HELLP综合征的诊治方法及终止妊娠的时机。方法12例患者均在严密监护下治疗，早期应用糖皮质激素，及时终止妊娠。结果HELLP综合征Ⅲ级5例，足月产3例，早产儿2例，死亡1例；HELLP综合征Ⅱ级4例，早产儿2例，足月儿2例；HELLP综合征I级3例，早产1例，足月儿2例，其中双胎1例。围生儿死亡率8．3％（1／12）。治疗4～6h终止妊娠8例，24～48h及72h终止妊娠各2例。12例患者均剖宫产痊愈出院。11例患者终止妊娠血小板1—3d恢复正常，1例终止妊娠后9d恢复正常。结论妊娠期高血压疾病予痫前期合并HELLP综合征应尽早诊断，积极治疗子痫前期疾病，适时终止妊娠。

Objective To analyze the diagnosis and treatment of preeclampsia complicated with HELLP syndrome and the time for termination of pregnancy. Methods Twelve patients with preeclampsia and HELLP syndrome were treated under intensive care. They took corticosteroids at early stage and terminated pregnancy timely. Results Among 5 cases with HELLP syndrome grade Ⅲ, 3 had full-term delivery and 2 had premature, and 1 infant died. Among 4 cases with HELLP syndrome grade Ⅱ, 2 infants were premature and 2 were fullterm. Among 3 patients with HELLP syndrome grade I, 1 infant was premature and 2 full-term, including one twins. Perinatal mortality rate was 8.3% （1/12）. The pregnancy of 8 patients was terminated within 4-6h of treatment with magnesium sulfate injection, of 2 cases in 24-48h and another 2 cases extended to 72 hours. The 12 patients underwent cesarean section and recovered. The platelet count returned to normal level within 1-3d after termination of pregnancy in 11 patients, and one returned 9d after termination of pregnancy. Conclusion The preeclampsia complicated with HELLP syndrome should be diagnosed as early as possible. Preeclampsia needs to be treated actively, and pregnancy should be tenninated at proper time.