单胎妊娠重度先兆子痫并发HELLP综合征22例临床治疗分析

Analysis on clinical treatment of 22 patients of single pregnancy with severe preeclampsia combined with HELLP syndrome

目的:探讨重度先兆子痫并发HELLP综合征对母儿结局的影响。方法:以重度先兆子痫101例(单胎妊娠91例,双胎10例)为研究对象,将其中重度先兆子痫并发HELLP综合征26例(单胎妊娠22例,双胎4例)中22例单胎妊娠并发HELLP综合征病患为HELLP组,重度先兆子痫对照综合征75例(单胎妊娠69例,双胎6例)中69例单胎妊娠对照综合征病患为对照组,回顾性分析HELLP组和对照组孕妇的母儿结局。结果:HELLP组中最高舒张压、确诊孕周和终止妊娠孕周分别为(107.41±20.17)mm Hg、(32.17±4.80)周和(32.34±5.02)周,对照组分别为(97.39±13.49)mm Hg、(35.12±3.67)周和(34.80±4.02)周,两组差异均有统计学意义(P<0.05)。HELLP组期待治疗时间(1.42±2.71)天与对照组(2.51±3.52)天比较差异无统计学意义(P>0.05),HELLP组剖宫产率59.09%与对照组82.61%比较差异有统计学意义(P<0.05)。两组尿蛋白、使用硫酸镁剂量差异均无统计学意义(P>0.05)。HELLP组使用静脉降压药物、多浆膜腔积液、眼底痉挛渗出及低氧血症发生率分别为31.82%、63.64%、45.45%和18.18%,对照组分别为4.35%、10.14%、13.04%和4.35%,两组比较差异均有统计学意义(P<0.05)。HELLP组新生儿体质量(1 751.80±1 027.13)g与对照组(2 474.20±946.61)g比较差异有统计学意义(P<0.05)。HELLP组孕产妇死亡1例,死儿丢失9例;对照组未发生孕妇死亡,发生死儿丢失4例。结论:重度先兆子痫一旦并发HELLP综合征则表示病情危重,因HELLP综合征的发病孕周早将可能阻碍胎盘功能发挥,从而引发胎儿发育受限甚至发生死胎,其可严重影响母儿结局,而采取积极的治疗干预可争取较好的母儿结局。

Objective： To explore the effect of severe preeclampsia combined with HELLP syndrome on maternal and fetal outcomes. Methods： A total of 101 patients with severe preeclampsia（ 91 patients of single pregnancy and 10 patients of twin pregnancy） were selected as study objects,22 patients of single pregnancy with severe preeclampsia combined with HELLP syndrome were selected as HELLP group,69 patients of single pregnancy with severe preeclampsia were selected as control group; maternal and fetal outcomes in HELLP group and control group were analyzed retrospectively. Results： In HELLP group,the maximum diastolic blood pressure,gestational weeks for definite diagnosis and gestational weeks for terminating pregnancy were（ 107. 41 ± 20. 17） mm Hg,（ 32. 17 ± 4. 80） weeks and（ 32. 34 ±5. 02） weeks,respectively,while in control group,the parameters were（ 97. 39 ± 13. 49） mm Hg,（ 35. 12 ± 3. 67） weeks and（ 34. 80 ±4. 02） weeks,respectively,there were statistically significant differences between the two groups（ P〈0. 05）. The expectant treatment time in HELLP group and control group were（ 1. 42 ± 2. 71） days and（ 2. 51 ± 3. 52） days,respectively,there was no statistically significant difference（ P〈0. 05）. The rates of cesarean section in HELLP group and control group were 59. 09% and 82. 61%,respectively,there was statistically significant difference（ P〈0. 05）. There was no statistically significant difference in urine protein level and dose of magnesium sulfate between the two groups（ P〈0. 05）. The rates of using intravenous antihypertensive drugs,polyserositis,fundus spasm exudation and hypoxemia were 31. 82%,63. 64%,45. 45%,18. 18% in HELLP group and 4. 35%,10. 14%,13. 04%,4. 35% in control group,there were statistically significant differences between the two groups（ P〈0. 05）. Neonatal body weights in HELLP group and control group were（ 1 751. 80 ± 1 027. 13） g and（ 2 474. 20 ± 946. 61） g,respectively,there was statistically significant difference between the two groups（ P〈0. 05）. In HELLP group,one pregnant woman died and stillbirth occurred in nine fetuses; in control group,no maternal death occurred,stillbirth occurred in four fetuses. Conclusion： Severe preeclampsia combined with HELLP syndrome means critical condition,early onset of HELLP syndrome may hinder placental function and induce fetal growth restriction or stillbirth,which may affect maternal and fetal outcomes significantly,active treatment intervention can achieve better maternal and fetal outcomes.