妊娠期急性脂肪肝26例临床分析

Clinical analysis on 26 patients with acute fatty liver of pregnancy

目的:探讨妊娠期急性脂肪肝(AFLP)的临床特点、诊断及治疗方法,以降低孕产妇和围产儿死亡率。方法:回顾性分析因妊娠期急性脂肪肝住院的26例患者临床表现、实验室检查、诊治情况和母婴结局。结果:26例病例中,早期出现厌食、乏力、恶心等症状21例,皮肤黄染19例,肝酶增高和凝血功能异常26例,胆红素升高21例,急性肾功能不全19例,弥漫性血管内凝血(DIC)16例,产后出血18例,肝性脑病6例,宫缩乏力5例;术中均尽早行Blynch缝合,无1例子宫切除;产妇死亡1例,死胎3例,新生儿轻度窒息4例,重度窒息1例,均抢救成功。结论:加强产检,重视孕妇妊娠晚期消化道症状和实验室检查异常,对AFLP尽早诊断、尽快终止妊娠、加强多学科的综合治疗可有效降低母婴死亡率。

Objective： To explore the clinical features,diagnosis and therapy of acute fatty liver of pregnancy（AFLP） to reduce the mortalities of pregnant women and perinatal infants.Methods： The clinical manifestations,laboratory examination,diagnosis,treatment,maternal and infantile outcomes of 26 patients who went to the hospital because of AFLP were analyzed retrospectively.Results： Among 26 patients,21 patients were found with anorexia,fatigue and nausea at early stage,19 patients were found with skin jaundice,26 patients were found with increase of liver enzymes and abnormal coagulation function,21 patients were found with increase of bilirubin,19 patients were found with acute renal insufficiency,16 patients were found with disseminated intravascular coagulation（DIC）,18 patients were found with postpartum hemorrhage,6 patients were found with hepatic encephalopathy,5 patients were found with uterine inertia;Blynch suture was conducted as early as possible during operation,hysterectomy didn＇t be performed;one parturient woman died and three fetal deaths were found;four neonates were found with mild asphyxia and one neonate was found with severe asphyxia,all the neonates were rescued successfully.Conclusion： Prenatal examination should be strengthened,digestive tract symptoms and abnormal laboratory examination results during the third trimester of pregnancy should be paid more attention to,the patients with AFLP should be diagnosed as early as possible,and pregnancy should be terminated quickly,multi-disciplined and comprehensive treatment can effectively reduce maternal and infantile mortalities.