妊娠高血压综合征并发溶血、肝酶升高及血小板减少综合征14例临床分析

A report of fourteen cases with hemolysis, elevated liver enzymes and low platelet count syndrome

目的 探讨与分析妊娠高血压综合征 (妊高征 )并发溶血、肝酶升高及血小板减少综合征 (HELLP综合征 )的发病率、诊断、治疗及预后。方法 对我院 7年来妊高征并发HELLP综合征 14例患者的临床资料进行回顾性分析。结果 HELLP综合征在重度妊高征患者中的发病率为 8% ,参考美国Tennessee大学制定的诊断标准 ,完全性HELLP综合征 8例 ,部分性HELLP综合征 6例。治疗方法为严密监护母儿情况下积极治疗妊高征 ,早期使用糖皮质激素 ,尽快终止妊娠。主要并发症为DIC、肝被膜下血肿、胎盘早剥、肺水肿和急性肾功能衰竭等。 14例患者中死亡 1例 ,围产儿死亡 4例 ,死亡率分别为 7%及 2 9%。结论 HELLP综合征是重度妊高征的一种严重威胁母儿安全的并发症 ,及早发现并应用糖皮质激素治疗 。

Objective To summarize the incidence, diagnosis, treatment and prognosis of patients with hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome. Methods The clinical data of fourteen cases with HELLP syndrome complicated by severe pregnancy-induced hypertension were analyzed retrospectively during the past seven years. Results The incidence of HELLP syndrome was 8% in the patients with severe pregnancy-induced hypertension. According to the diagnosis criteria used by Tennessee University, there were eight cases with complete HELLP syndrome and six cases with partial HELLP syndrome. The major therapeutic way were intensive maternal and fetal monitoring, active management of preeclampsia and eclampsia, administration of corticosteroids and termination the pregnancy as fast as possible. The major complications were DIC, placental abruption, pneumonedema and acute renal failure. The maternal and perinatal mortality were 7% and 29%, respectively. Conclusions HELLP syndrome was a serious life-threatening complication of severe pregnancy- induced hypertension. In order to decrease the maternal and perinatal mortality rate, HELLP syndrome should be diagnosed and treated as fast as possible.