妊娠合并HELLP综合征15例临床分析

Clinical analysis on 15 pregnancies complicated HELLP syndrome

目的:探讨HELLP综合征的自然病程、早期的诊治方法及母婴预后。方法:对我院及长春市妇产科医院13年来HELLP综合征15例患者的临床资料进行回顾性分析。结果:许多孕妇一开始可能被误诊为内、外科并发症,HELLP综合征的恢复时间为4～11 d(平均6.5 d),治疗方法为严密监护母儿情况下积极治疗妊高征,适当输注血制品,早期使用糖皮质激素,尽快终止妊娠。终止妊娠以全麻下行剖宫产为宜,宫颈成熟可经阴道分娩。HELLP综合征的主要并发症为DIC、胎盘早剥、严重胸腹水等。15例患者中死亡1例,围生儿死亡8例,死亡率分别为7.0％及53.3％。结论:掌握HELLP临床表现、自然病程及实验室检查的特点,及早明确诊断,在积极治疗重度妊高征的基础上,适当输注血制品并早期应用糖皮质激素,及时终止妊娠,以全麻下行剖宫产为宜,加强产前检查。

Objective: To summarize the natural history, early diagnosis, treatment and prognosis of mother and fetus with HELLP syndrome. Methods: The clinical data of fifteen cases with HELLP syndrome were analyzed retrospectively during the past thirteen years in this hospital and the institute of Obstetrics and Gynecology of Changchun. Results: Some pregnancies were misdiagnosed as the complication of medical or surgical disorder. The time course of HELLP syndrome was 4～11 days (median duration was 6.5 days). In the condition of monitoring the mother and fetus, they treated actively pregnancy-inducing hypertension syndrome (PIH), transfused blood products correctly, used corticosteroids early and delivered at term. General anesthesia for cesarean delivery was right, while vaginal delivery was agreeable if cervix uteri were mature. The main complication of HELLP syndrome was disseminated intravascular coagulopathy (DIC), abruption placenta, severe ascites, and so on. One of 15 patients and eight fetuses were dead. Their mortality were respectively 7% and 53.3%. Conclusion: The clinical manifestations, natural history and laboratory outcomes of HELLP syndrome should be grasped and early diagnosed. To diagnosis early, treat actively PIH, transfuse blood products, use early corticosteroids and cesarean deliver in the general anesthesia should be paid attection to. Antepartum monitor and prophylaxis is necessary.