重度妊娠高血压合并HELLP综合征临床分析

Clinical analysis of severe pregnancy-induced hypertension combined with HFLLP syndrome

目的 探讨分析重度妊娠高血压并发HEL.LP综合征的发病率、诊断、治疗及预后.方法 回顾性分析18例重度妊娠高血压合并HELLP综合征患者的病例资料,将患者按照血小板计数分型分为两组：Ⅰ级HELLP综合征组（11例）与Ⅱ级HELLP综合征组（7例）.对两组患者的各项指标变化情况以及母婴并发症发生情况进行分析.结果 Ⅰ级HELLP综合征组门冬氯酸氨基转移酶、乳酸脱氢酶高于Ⅱ级HELLP综合征组,血小板计数低于Ⅱ级HELLP综合征组,差异均有统计学意义（P＜0.05）.Ⅰ级HELLP综合征组孕产妇发生弥散性血管内凝血的概率及围生儿发生胎儿宫内发育迟缓的概率均高于Ⅱ级HELLP综合征组,差异均有统计学意义（P＜0.05）.18例患者中1例死于产后HELLP综合征,围生儿死亡3例.结论 HELLP综合征是重度妊娠高血压疾病的一种严重威胁母婴安全的并发症,尤其是Ⅰ级HELLP综合征,及早发现并应用糖皮质激素治疗,终止妊娠是治疗最有效的措施,可以降低母婴死亡率.

Objective To investigate the incidence,diagnosis,treatment and prognosis of severe pregnancy-induced hypertension combined with HELLP syndrome.Methods The clinical data of 18 patients with severe pregnancy-induced hypertension combined with HELLP syndrome were retrospectively analyzed,and these patients were divided into two groups according to platelet count type,type Ⅰ HELLP syndrome group （11 cases） and type Ⅱ HELLP syndrome group （7 cases）.Indicators changes in the two groups of patients and occurrence of maternal complications were analyzed.Resuits AST and LDH in type Ⅰ HELLP syndrome group was higher than that in type Ⅱ HELLP syndrome group,while PLT was less than that in type Ⅱ HELLP syndrome group,and differences were significant（P 〈0.05）.The incidences of DIC and FGR were higher in type Ⅰ HELLP syndrome group,there were significant differences（P 〈0.05）.One case died of postpartum HELLP syndrome and 3 cases died in perinatal period during the 18 cases.Conclusions HELLP syndrome is a serious complication of severe pregnancy-induced hypertension threatening the safety of maternal,specially in patients with type Ⅰ HELLP syndrome.The most effective treatment are early detection,treatment of glucocorticoid and termination of pregnancy,which can reduce the mortality of maternal and child.