溶血、肝酶升高与血小板减少综合征的临床分析

Clinical analysis of HELLP syndrome

目的分析溶血、肝酶升高与血小板减少（HELLP）综合征患者的临床资料和母婴的结局，为临床诊治工作提供依据。方法选取1991至2010年间所有河南鹤壁煤业医院妇产科收住的足月妊娠的孕妇的临床资料，回顾性分析1991至2000年和2001至2010年这两个时间段HELLP综合征发生率及患者的临床预后及妊娠结局。结果①1991年至2010年间，共有HELLP综合征病人203例，32例伴子痫，HELLP综合征患者伴子痫者约为15．8％；②HELLP综合征初产妇较非HELLP综合征初产妇的平均年龄小，有统计学意义（t=12．30，P〈0．05），子痫发生率、产妇的死亡率、新生儿的死亡率更高（X^2值分别为689．61、14．48和345．68，均P〈0．05）；@HELLP综合征经产妇较非HELLP综合征经产妇的平均年龄更小（t=12．30，P〈0．05），子痫发生率、产妇的死亡率、新生儿的死亡率更高（X^2值分别为656．60、16．43和354．65，均P〈0．05）；④HELLP综合征初产妇伴子痫者较不伴子痫者的平均年龄更小（t=13．31，P〈0．05），新生儿的死亡率更高（X^2=6．63，P〈0．05），HELLP综合征经产妇伴子痫者较不伴子痫者的平均年龄更小（t=14．30，P〈0．05），新生儿的死亡率更高（／=2．85，P〈0．05）。结论两时期比较显示，HELLP综合征及其伴发子痫发生率并未显著下降，HELLP无论是否伴发子痫均使产妇和新生儿死亡率增加。

Objective To analyze of the clinical data of patients with hemolysis, elevated liver enzymes and low platelet count （HELLP） syndrome and the maternal and neonatal outcomes. Methods A retrospective study was conducted to analyze the prevalence of HELLP syndrome among hospitalized patients in the period of 1991 to 2000 and 2001 to 2010 as well as clinical prognosis and pregnant outcomes. Results In the period of 1991 to 2010 203 cases were diagnosed with HELLP syndrome, of which 32 cases were found with eclampsia, accounting for 15.8%. Uniparous women with HELLP syndrome were younger than those without HELLP syndrome （ t = 12.30, P 〈 0.05）. The incidence of eclampsia, maternal mortality, and neonatal mortality were higher in cases with HELLP syndrome （Xz value was 689.61, 14.48 and 345.68, respectively, all P 〈 0.05 ）. Compared with parturient women without HELLP syndrome, theose with HELLP syndrome were younger （t = 12.30, P 〈 0.05 ）, and the incidence of eelampsia, maternal mortality and neonatal mortality were higher （X^2 value was 656.60, 16.43 and 354.65, respectively, all P 〈 0.05 ）. Compared with uniparous women with HELLP syndrome not complicating eelampsia, those complicating eclampsia were younger （ t = 13.31, P 〈 0.05 ）, and their neonatal mortality was higher （X^2 = 6.63, P 〈 0.05 ）. The parturient women with HELLP syndrome complicating eelampsia were younger （ t = 14.30, P 〈 0.05 ） and their neonatal mortality was higher （X^2 = 2.85, P 〈 0.05 ）. Conclusion Comparison between two periods indicates that the prevalence of HELLP syndrome and that of HELLP syndrome with eelampsia do not decline. Maternal and neonatal mortality will increase regardless of HELLP syndrome with or without eclampsia.