妊娠合并HELLP综合征的诊治进展

HELLP综合征是子痫前期的严重阶段,主要表现为溶血、肝酶升高和血小板减少,可引起多脏器功能障碍,如脑水肿、脑出血、视网膜脱落、肺水肿、肝包膜血肿、胎盘早剥及胎儿生长受限等。临床表现缺乏特异性,乳酸脱氢酶(LDH)和肝酶异常是早期敏感指标,动态监测血小板计数是评估病情的重要指标。一旦诊断为HELLP综合征应立即解痉、降压,必要时给予地塞米松升血小板、促胎肺成熟治疗,根据血小板水平考虑是否输注血小板。病情危重者应及时终止妊娠,可适当放宽剖宫产指征,术中注意液体量管理,预防心衰。考虑胎儿存活能力较低或死胎者,可经阴引产,产后应加强护理。

HELLP syndrome is a serious stage of preeclampsia,mainly manifested as hemolysis,elevated liver enzymes and thrombocytopenia. It can cause multiple organ dysfunction syndromes,such as cerebral edema,cerebral hemorrhage,retinal detachment,pulmonary edema,hepatic hematoma,placental abruption and fetal growth restriction. Clinical manifestations of HELLP syndrome lack specificity, but abnormal lactate dehydrogenase and liver enzymes are early sensitive indicators,and dynamic monitoring of platelet count is an important indicator to assess the disease. Once diagnosed with HELLP syndrome,patients should be given immediately antispasmodic and antihypertensive therapy. Dexamethasone is given when necessary to promote platelet level and fetal lung maturation. Platelet transfusion can be considered according to the level. The patient who is in critical condition should terminate the pregnancy in time,and relax the indications of cesarean section,pay attention to the management of fluid volume and prevent heart failure. It can be induced labor through vagina considering fetal viability is low or stillbirth. Postpartum care should be strengthened.