产前HELLP综合征并发可逆性后部白质脑病综合征一例

A Case of Prenatal HELLP Syndrome Complicated with Reversible Posterior Leukoencephalopathy Syndrome

HELLP综合征及可逆性后部白质脑病综合征(reversible posterior leukoencephalopathy syndrome,RPLS)发病机制尚不清楚,治疗缺少临床指南的统一指导。报告1例产前HELLP综合征并发RPLS患者,产前以头痛、失明为主要临床表现,血压升高,辅助检查提示乳酸脱氢酶、丙氨酸转氨酶及天冬氨酸转氨酶升高,血小板下降,急诊子宫下段剖宫产术后发生寒战、抽搐,时有烦躁不安等谵妄症状,予镇痛、镇静、降压、利尿、抗感染和保肝等对症治疗,10 d后病情稳定,视力恢复正常,血压控制平稳。对于妊娠期高血压疾病患者,出现神经、视觉障碍症状者需考虑合并RPLS的可能性,尽早诊断及治疗,保障母婴安全。

The pathogenesis of HELLP syndrome and reversible posterior leukoencephalopathy syndrome(RPLS)is still unclear,lack of unified guidance in clinical treatment.A case of prenatal HELLP syndrome complicated with RPLS was reported.The main clinical manifestations of the patients were headache and blindness,the blood pressure was elevated.Laboratory examination showed that lactate dehydrogenase,alanine aminotransferase and aspartate aminotransferase increased,and platelets decreased.Patient has chills,convulsions irritability and other delirium symptoms after emergency lower segment cesarean section,was given rescue treatment such as analgesia,sedation,antihypertensive,diuresis,anti-infection,liver protection and multidisciplinary consultation.After 10 days,the patient′s condition was stable,with normal vision and stable blood pressure control.For patients with hypertensive disorders during pregnancy,those with symptoms of neurological and visual disturbances should consider the possibility of RPLS,and diagnose and treat as soon as possible to ensure maternal and infant safety.