HELLP综合征剖宫产术的麻醉管理

Anesthetic managements of cesarean section in HELLP syndrome

目的:探讨HELLP综合征产妇行剖宫产术的麻醉管理要点,为提高HELLP患者的母婴生存率提供新的麻醉管理依据和新思路。方法:回顾分析2011年1月—2021年12月武汉大学人民医院26例HELLP综合征产妇的剖宫产麻醉管理临床资料。结果:26例患者术前均应用了糖皮质激素和硫酸镁进行治疗,其中椎管内麻醉4例,全身麻醉22例,术中积极维持患者生命体征平稳,科学进行容量管理,同时积极纠治患者凝血功能。术后10例血流动力学不平稳或合并严重并发症者转入重症医学科进一步治疗,治疗时长1~5 d转出ICU;新生儿Apgar评分8~10分,其中2例新生儿回新生儿ICU进一步治疗。患者麻醉期间基本平稳,未见严重的新生儿并发症,母婴均安全出院。结论:HELLP综合征是发生于孕中晚期的急危重症,选择合适手术时机终止妊娠是其治疗的根本方式,科学的麻醉方式和围术期管理可以提高母婴生存率,改善预后。

Objective:To review the clinical experiences and recent research focus of HELLP syndrome,and to explore the key points of anesthesia managements of parturient with HELLP syndrome for providing new ideas and treatment basis to improve parturient and infant survival.Methods:The clinical data of 26 HELLP patients with cesarean section from January 2011 to December 2021 in Renmin Hospital of Wuhan University were retrospectively analyzed.Results:All the 26 patients were treated with glucocorticoid and magnesium sulfate before operation,and 4 cases of them received spinal anesthesia and 22 received general anesthesia during cesarean section.The maintenance of stable vital signs,scientific volume management,and active correction of coagulation were performed during surgery.Ten patients with hemodynamic instability or severe complications were transferred to intensive medicine department for about 1-5 days further treatment.The Apgar′s scores of newborns were 8-10,and 2 newborns were transferred to neonatal ICU for further treatment.No serious neonatal complications were seen,and the mother and infants were discharged safely from hospital.Conclusion:HELLP syndrome is a serious complication,usually occurs in the second and third trimesters of pregnancy,and it is vital to terminate the pregnancy properly.Scientific anesthesia methods and perioperative managements can improve the survival rate and prognosis of parturient and infant.