产后溶血性尿毒症3例病例分析及文献复习

Analysis of 3 Cases of Postpartum Hemolytic Uremia and Review of Literature

目的:总结产后溶血性尿毒症的高危因素、临床表现、辅助检查、鉴别诊断及治疗方法,提高对本病的认识,达到早期诊断、早期干预,降低患者死亡率,改善预后。方法:回顾性分析就诊于荆州市第一人民医院的3例产后溶血性尿毒症的患者并复习相关文献。结果:3例患者均有发生产后溶血性尿毒症的高危因素,并于产后24~48 h出现无尿/少尿,实验室检查提示溶血性贫血或消耗性凝血病、血小板减少及肾功能损害。予以血浆置换、血液透析、肾脏替代疗法、激素等对症治疗后,2例患者肾功能持续好转后出院,1例患者死亡。结论:产后溶血性尿毒症临床少见,症状无特异性,早期诊断困难,因此当患者合并产后溶血性尿毒症的高危因素时均应警惕产后溶血性尿毒症的发生。

Objective: To summarize the high risk factors, clinical manifestations, auxiliary examination, dif-ferential diagnosis and treatment of postpartum hemolytic uremia, so as to improve the under-standing of this disease, achieve early diagnosis and intervention, reduce the mortality of patients and improve the prognosis. Methods: 3 cases of postpartum hemolytic uremia treated in Jingzhou First People’s Hospital were analyzed retrospectively and related literatures were reviewed. Re-sults: All the three patients had high risk factors for postpartum hemolytic uremia, and anuria/ ol-igarch occurred from 24 h to 48 h after delivery. Laboratory examination indicated hemolytic ane-mia or wasting coagulation disease, thrombolytic and renal function impairment. After symptomat-ic treatment such as plasma exchange, dialysis, kidney replacement therapy and hormone, 2 pa-tients were discharged from hospital after continuous improvement of renal function, and 1 patient died. Conclusion: Postpartum hemolytic uremia is rare in clinic, the symptoms are not specific, and the early diagnosis is difficult. Therefore, the occurrence of postpartum hemolytic uremia should be vigilant when patients are combined with high-risk factors of postpartum hemolytic uremia.