溶血、肝酶升高及血小板减少综合征患者终止妊娠时间对母儿预后的影响

Maternal and perinatal prognosis affected by the time of termination of pregnancy in patients with hemolysis elevated liver enzymes and low platelet syndrome

目的 探讨溶血、肝酶升高及血小板减少综合征 (HELLP)患者终止妊娠的最佳时间及其对母儿预后的影响。方法 收集 1 992年 1 0月至 2 0 0 1年 9月 ,57例HELLP综合征患者的临床资料 ,按诊断至分娩时间长短不同分为 3组。Ⅰ组 :确诊后 2 4h内终止妊娠 ;Ⅱ组 :确诊后 2 4～ 48h终止妊娠 ;Ⅲ组 :确诊 48h后终止妊娠。对 3组母儿围产期并发症和死亡率进行回顾性分析。结果 (1 ) 3组孕产妇死亡率及围产儿死亡率分别为 ,Ⅰ组 7%及 1 1 % ,Ⅱ组 1 6 %及 2 1 % ,Ⅲ组 64 %及 73 %。Ⅲ组的孕产妇死亡率及围产儿死亡率明显高于Ⅰ、Ⅱ组 ,两者比较 ,差异有显著性 (P <0 0 5)。 (2 )Ⅰ、Ⅲ组孕产妇并发DIC、急性肾功能衰竭及新生儿窒息的发生率分别为 ,Ⅰ组 :1 1 %、4 %及 1 9% ,Ⅲ组 :55 %、36 %及 64 % ,Ⅲ组明显高于Ⅰ组 (P <0 0 5)。 (3)Ⅰ、Ⅱ组孕产妇并发急性肾功能衰竭的发生率分别为 4 %及 37% ,Ⅱ组明显高于Ⅰ组 (P <0 0 1 )。结论 HELLP综合征患者一旦确诊应尽快终止妊娠 ,终止妊娠最佳时间为诊断后 48h内。继续妊娠对孕产妇预后有严重影响 ,终止妊娠时间越晚 。

Objective To investigate the optimal time of termination of pregnancy for patients with hemolysis elevated liver enzymes and low platelet (HELLP) syndrome Methods 57 patients with HELLP syndrome admitted from October 1992 to September 2001 were enrolled According to the length from the time diagnoses confirmed to the time of delivery,patients were divided into 3 groups; group Ⅰ,within 24 hours, group Ⅱ,24 to 48 hours and group Ⅲ,over 48 hours Complications,maternal and perinatal mortality were analyzed retrospectively between different groups Results Maternal and perinatal mortality were 7% and 11% in group Ⅰ, 16% and 21% in group Ⅱ, 64% and 73% in group Ⅲ with significant differences between group Ⅲ and group Ⅰ or group Ⅲ and group Ⅱ ( P <0 05) Incidence of DIC, ARF and neonatal asphyxia was 11%,4% and 19% in group Ⅰ compared with 55%,36% and 64% in group Ⅲ,significantly higher in group Ⅲ than those in group I( P <0 05) Incidence of ARF in maternal was 4% in group Ⅰ and 37% in group Ⅱ with significant difference( P <0 05) Conclusion Pregnancy should be terminated as soon as possible once diagnosis of HELLP is confirmed with optimal time within 48 hours