重度子痫前期合并HELLP综合征行剖宫产10例术后护理

目的:探讨重度子痫前期合并HELLP综合征剖宫产术后患者的护理方法.方法:对10例重度子痫前期合并HELLP综合征行剖宫产手术孕妇的临床护理资料进行回顾性分析.结果:术后产后出血2例,急性肾功能衰竭1例,经积极处理均好转.结论:术后细致观察、预防出血、控制血压,注意镇静、镇痛,重视产妇的心理护理及保持环境安静舒适,是减少重度子痫前期合并HELLP综合征剖宫产术后并发症发生的重要措施.     

伴腹腔积液重度子痫前期的临床分析

目的探讨伴腹腔积液重度子痫前期患者的临床特点、治疗方法及对母婴预后的影响。方法对我院收治的伴腹腔积液重度子痫前期20例的临床资料进行回顾性分析。结果 20例均有不同程度的高血压、水肿,查血浆白蛋白降低、尿蛋白增高、肝肾功能异常,均出现腹腔积液。并发肾功能损伤5例,产后出血4例,胎盘早剥3例,胸腔积液并不同程度肝功能损伤2例,子痫、HELLP综合征各1例。经积极救治并及时终止妊娠,20例共分娩21例新生儿,剖宫产18例,顺产2例,围产儿胎龄30.4~37.0周;无一例胎儿死亡,出生时6例重度窒息,8例轻度窒息。20例腹腔积液均于术后8~14 d消失,皆于术后8~14 d出院,无一例产妇死亡。结论伴腹腔积液重度子痫前期患者病情重,严重并发症和围生儿不良结局发生率高,及早发现并治疗,适时终止妊娠,可改善预后。     

重度子痫前期剖宫产96例术后护理

目的:探讨重度子痫前期患者剖宫产术后的护理方法。方法:对96例重度子痫前期患者对症治疗,及时采取剖宫产手术结束分娩,术后给予积极治疗与护理。结果:本组产妇入院后均行剖宫产术,96例患者术后未发生子痫,有2例发生早期心力衰竭,经积极治疗均痊愈出院。结论:重度子痫前期患者术后给予积极的抢救护理有助于患者及时康复,预防并发症的发生,保障母婴安全。     

4例肝病合并重症HELLP综合征患者剖宫产术后的护理

总结4例肝病合并重症HELLP综合征产妇剖宫产术后的护理要点。持续按摩以促进子宫收缩,注重凝血功能的观察护理,以防患者出血,做好并发肝衰竭、呼吸衰竭和肾衰竭患者的对症护理,以提高肝病合并重症HELLP综合征患者抢救成功率。本组4例肝病合并HELLP综合征剖宫产术后产妇无1例死亡,均痊愈出院。     

重度哮喘合并产后子痫1例临床护理

目的:探讨重度哮喘合并产后子痫患者的护理方法。方法:分析总结1例重度哮喘合并产后子痫的临床资料。结果:1例重度哮喘合并产后子痫患者于剖宫产术后2 h发生子痫昏迷、心搏骤停,经过积极抢救,给予有效的治疗和精心的护理,母婴平安出院。结论:对重度哮喘合并产后子痫患者进行积极抢救和精心护理,可转危为安。     

循证护理对重度子痫前期合并HELLP综合征患者的影响

目的:探讨循证护理对重度子痫前期合并HELLP综合征患者术后并发症发生率及患者满意度的影响,评估循证护理的临床应用价值。方法:将62例重度子痫前期合并HELLP综合征患者随机分为对照组和实验组各31例,对照组给予常规护理,实验组给予循证护理。比较两组术后并发症发生率及患者满意度。结果:实验组并发症发生率明显低于对照组(P0.05),患者满意度高于对照组(P0.05)。结论:对重度子痫前期合并HELLP综合征患者实施循证护理,能够显著降低患者并发症发生率,提高患者满意度,值得临床推广应用。     

循证护理干预在重度子痫前期剖宫产术后产妇中的应用

目的:探讨循证护理干预在重度子痫前期剖宫产术后产妇中的应用方法及效果。方法:将62例重度子痫前期剖宫产术后产妇按照随机数字表法分为研究组和对照组各31例,对照组给予妇产科产后常规护理干预,研究组给予循证护理干预,比较两组护理效果。结果:研究组术后并发症发生率低于对照组(P0.05),护理满意度高于对照组(P0.05)。结论:循证护理干预可降低重度子痫前期剖宫产术后产妇的并发症发生率,提高护理满意度。     

重度子痫前期并HELLP综合征10例的护理

目的：探讨再度子痫前期并HELLP综合征治疗过程中的护理要点。方法：对我院收治10例重度子痫前期并HELLP综合征患者的临床资料进行回顾性分析。结果：10例患者中合并胎盘早剥4例,急性肾功能衰竭1例,产后出血2例,10例患者均痊愈出院,围产儿死亡2例。结论：重视产前检查,积极治疗妊娠期高血压病,及早发现HELLP综合征并积极治疗,适时终止妊娠,进行有效的护理,降低孕产妇及围产儿死亡率。     

子痫前期重度剖宫产术后的护理

目的总结子痫前期重度剖宫产术后的护理要点,预防产后子痫并发症的发生,提高护理水平及护理质量。方法2007年1-12月对60例子痫前期重度产妇实施剖宫产术,并配合做好术后护理。结果术后无1例发生子痫,有1例发生早期心力衰竭,经处理好转。结论术后细致的观察、控制血压,注意镇静、镇痛,重视产妇的心理护理及保持环境安静舒适,是减少子痫前期重度剖宫产术后子痫发生的重要措施。     

循证护理在重度子痫前期剖宫产术后并发症产妇中的应用

目的:探讨循证护理在重度子痫前期剖宫产术后并发症产妇中的应用方法及效果。方法:对28例重度子痫前期剖宫产术后并发症产妇实施循证护理,观察护理效果。结果:本组28例产妇经及时抢救、治疗及精心护理,病情均得到有效控制,康复出院,住院时间10~12 d。结论:对重度子痫前期剖宫产术后并发症产妇实施循证护理效果较好,有利于改善产妇预后。     

Plasma exchange for preeclampsia: II. Unsuccessful antepartum utilization for severe preeclampsia with or without hellp syndrome

OBJECTIVE: To explore the efficacy of plasmapheresis/plasma exchange as the primary therapy to arrest and reverse the progression of severe preeclampsia with or without HELLP syndrome in order to postpone delivery and improve perinatal outcome in very preterm pregnancies. STUDY DESIGN: In this case series of patients managed over a 4-year period from 1984 to 1987, seven gravidas with severe preterm preeclampsia underwent 1-2 plasmaphereses/plasma exchange procedures using the IBM 2997 Cell Separator with continuous electronic fetal heart rate monitoring (n = 7 patients) and central cardiovascular monitoring (n = 3 patients). RESULTS: The seven patients (one with HELLP syndrome, six without HELLP) presented between 24 and 30 weeks gestation and, despite plasmapheresis/plasma exchange, the severity of each study subject's preeclampsia persisted without clinically significant improvement. Maternal-fetal deterioration required cesarean delivery in all cases within 48 (in four patients within <36) hours of therapy. No clinically significant adverse effect of plasma exchange therapy was recorded during cardiovascular and laboratory monitoring; two fetuses developed repetitive late decelerations during exchange despite adequate maternal fluid preload. The only patient with HELLP syndrome developed eclampsia as her third plasma exchange within 25 hours was being initiated. Significant problems with fluid retention and displacement (variable amounts of pulmonary edema, pleural effusions, large volume ascites) were encountered in all patients. Four neonates died (24-27 weeks/438-820 g) and three survived intact (740, 950, and 1,280 g). One mother (case 5) developed end-stage renal disease 21 months postpartum. CONCLUSIONS: The application of plasmapheresis/plasma exchange therapy as described in order to prolong very preterm pregnancies in the undelivered patient with severe preeclampsia/eclampsia with or without HELLP syndrome did not produced encouraging results. Patients in general were exposed to additional medical and surgical risk without a corresponding improvement in perinatal outcome.     

护理干预对早发型重度子痫前期并发症的影响

目的探讨护理干预对早发型重度子痫前期并发症的影响。方法选择2010年1月1日至2011年12月31日120例期待治疗早发型重度子痫前期患者,随机分为干预组和对照组,各60例。对照组对早发型重度子痫前期患者进行常规治疗、护理,干预组在重度子痫前期常规治疗、护理基础上进行各项护理干预措施,比较两组并发症发生情况。结果干预组发生胎盘早剥1例,低蛋白血症3例,无HELLP综合征、心力衰竭、肾衰竭及子痫病例发生,母婴结局良好,无孕产妇及新生儿死亡。对照组发生心力衰竭3例,肾衰竭4例,胎盘早剥5例,HELLP综合征4例,低蛋白血症16例,子痫2例,无孕产妇死亡,但有2例新生儿因重度窒息死亡。两组间并发症比较差异有统计学意义（P〈0．05）。结论对早发型重度子痫前期患者进行护理干预措施,能减少胎盘早剥、院内子痫、心力衰竭、肾衰竭、低蛋白血症、HELLP综合征等并发症的发生,对提高早发型重度子痫前期患者的生存质量及围生儿的生命质量具有实际的临床意义。     

Increasing maternal weight: a risk factor for preeclampsia/eclampsia but apparently not for HELLP syndrome

BACKGROUND: Maternal obesity is a risk factor for severe preeclampsia. We sought to ascertain whether a similar relationship exists between maternal weight and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) as an atypical form of severe preeclampsia. METHODS: In this retrospective investigation, 434 patients with HELLP syndrome were assigned to one of four study groups according to maternal weight and were analyzed in relation to selected maternal and perinatal data reflective of disease severity. RESULTS: We found no significant associations between maternal weight and parameters of HELLP syndrome severity, race, delivery mode, gestational age, or perinatal outcome. Significantly associated with increasing maternal weight were maternal age, parity, admission mean arterial pressure, peak peripartum systolic blood pressures, concurrent essential hypertension, and the interval between admission and delivery. Inversely associated were eclampsia and the interval between delivery and discharge. CONCLUSIONS: Severity and complications attendant with HELLP syndrome appear unrelated to maternal weight. Paradoxically, eclampsia occurs most commonly in the lighter gravida with HELLP syndrome.     

妊娠合并血小板减少的病因及母婴结局分析

目的 探讨妊娠合并血小板减少（PT）的病因及母婴结局。方法 收集228例PT患者,其中血小板（51 ~ 100）×10⁹/L为轻度组,血小板（30 ~ 50）×10⁹/L为中度组,血小板< 30×10⁹/L为重度组,比较3组患者的病因和母婴结局的差异。结果 228例PT孕妇中,轻度血小板减少159例（69.8%）,中度血小板减少33例（14.5%）,重度血小板减少36例（15.8%）。主要病因有妊娠相关性血小板减少症（63.6%）、特发性血小板减少性紫癜（11.8%）、HELLP综合征（3.9%）、SLE（3.9%）和子痫前期-子痫（2.2%）。轻度组、中度组和重度组的妊娠丢失、早产、产后出血、新生儿血小板减少的发生率及分娩孕周比较差异均有统计学意义（P均< 0.05）,其中重度组的妊娠丢失率、早产率、产后出血率均高于轻度组,分娩孕周短于轻度组（P均< 0.017）。结论 PT的病因复杂多样,病因多见妊娠相关性血小板减少症、特发性血小板减少性紫癜、HELLP综合征、SLE和子痫前期-子痫。血小板< 30×10⁹/L的PT患者发生妊娠丢失、早产、产后出血的概率明显增加。     

重度子痫前期早产与自发性早产母儿结局的比较研究

目的探讨重度子痫前期导致的不同类型早产的母儿结局。方法比较分析142例重度子痫前期早产（病例组）与同期311例自发性早产（对照组）的母儿结局。两组均按分娩胎数和孕周分为单胎早期早产、单胎中型早产、单胎轻型早产、多胎〈34周、多胎≥34周5个亚组分别进行比较。结果病例组较对照组规律产检率低、剖宫产率和孕妇并发症发生率高、新生儿出生体重低,病例组中单胎总的新生儿死亡率和转儿科率均较对照组高,其差异有统计学意义（P〈0.05）。早期早产围生儿结局差,但病例组与对照组比较差异无统计学意义;中型早产和轻型早产的病例组新生儿较对照组儿科住院时间长,肺炎和吸入综合征发生率高,其差异有统计学意义（P〈0.05）;多胎合并重度子痫前期孕产妇心衰和产后出血发生率高。结论重度子痫前期严重影响胎儿发育及新生儿结局,单胎各组中重度子痫前期早产儿出生体重均低于同期自发性早产儿,单胎中型和轻型早产组中重度子痫前期早产新生儿不良结局的发生率较同期自发性早产高,单胎重度子痫前期总的新生儿死亡率和转儿科率均较同期自发性早产高;早期早产儿发病率、死亡率高与孕周小关系密切;多胎合并重度子痫前期孕产妇心衰和产后出血发生率高,应积极做好预防和保健工作。     

HELLP综合征16例临床分析

目的探讨子痫前期并发HELLP综合征的发病率、诊断、治疗及预后。方法对16例子痫前期并发HELLP综合征患者的临床资料进行回顾性分析。结果完全性HELLP综合征14例，部分性HELLP综合征2例。治疗方法为严密监护母儿情况下积极治疗子痫前期，早期使用糖皮质激素，适时终止妊娠。主要并发症为DIC、肝被膜下血肿、胎盘早剥、肺水肿和急性肾功能衰竭等。16例患者中死亡1例，围产儿死亡3例，死亡率分别为6．25％及18．75％。结论HELLP综合征是子痫前期的一种严重威胁母儿安全的并发症，早期诊断、综合性治疗、适时终止妊娠，可改善HELLP综合征患者的预后。     

Abdominal pain and preeclampsia: sonographic findings in the maternal liver.

OBJECTIVE: To describe sonographic findings in livers of pregnant women with severe preeclampsia and abdominal pain. METHODS: Over a 12-month period, we performed serial sonographic examinations on 32 pregnant women with severe preeclampsia and acute right upper quadrant and epigastric pain. On each sonogram we observed the liver size and texture, "periportal halo" sign, gallbladder wall, Glisson capsule thickness, painful compression of the liver and gallbladder, and ascites. The pancreas, spleen, kidneys, and uterus were also studied. Sonography was repeated after delivery. RESULTS: Initial sonograms showed liver abnormalities in 28 patients. Abnormalities consisted of liver hypertrophy (n = 24), hyperechoic thickening of the periportal area (periportal halo sign; n = 23), striated thickening of the gallbladder wall (n = 27), hyperechoic thickening of the Glisson capsule (n = 11), liver areas of increased echogenicity (n = 11), subcapsular hematoma (n = 1), and subcapsular calcification (n = 1). Probe compression of the liver enhanced abdominal pain (n = 13), whereas the gallbladder was painless in all cases. No gallbladder stones were detected. Ascites (n = 16) and pleural effusion (n = 11) were also present. In no case did we detect abnormalities of the pancreas, kidneys, or spleen. All patients eventually had hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome according to the American College of Obstetricians and Gynecologists classification. In 7 cases, HELLP syndrome developed postpartum. Three patients also had eclampsia. Follow-up sonograms highlighted quick regression of abnormalities after delivery. CONCLUSIONS: The livers of women with severe preeclampsia who had HELLP syndrome showed sonographic abnormalities before biological abnormalities. Serial sonographic examinations could therefore contribute to the obstetric care of these women. Preeclampsia and HELLP syndrome should be routinely checked for in all pregnant women with acute abdominal pain.     

HELLP syndrome leading to a diagnosis of pregnancy

HELLP syndrome (an acronym for hemolysis, elevated liver enzymes, and low platelets) is a life-threatening complication of pregnancy seen in association with either preeclampsia or eclampsia. HELLP syndrome is rarely diagnosed before 24 weeks of gestation. This atypical form of severe preeclampsia is associated with significant fetal and maternal mortality. The only effective treatment is delivery. We report a case of HELLP syndrome that proved to be a diagnostic clue to an early pregnancy.     

Leukocytosis is proportional to HELLP syndrome severity: evidence for an inflammatory form of preeclampsia

BACKGROUND: We investigated the possibility that HELLP syndrome is in part a systemic inflammatory response. METHODS: We evaluated total white blood cell (WBC) counts of all patients with severe preeclampsia with and without HELLP syndrome admitted to our hospital between 1995 and 1997. Patients were grouped by diagnosis and timing of platelet nadir. Analysis of variance and regression analysis were used for data analysis. RESULTS: Of 177 patients, 91 had HELLP syndrome, and 86 had severe preeclampsia alone. The WBC counts were significantly higher in patients with HELLP syndrome (12.5 +/- .442 x 10(9)/L) than in patients with severe preeclampsia (10.3 +/- .288 x 10(9)/L). Regression analysis showed that platelet counts varied inversely with WBC counts. Also, patients with class I HELLP syndrome had significantly higher WBC counts than patients with other classes of HELLP syndrome. CONCLUSION: The finding of an association between increasing leukocytosis and worsening thrombocytopenia early in the course of HELLP syndrome supports the hypothesis that it may represent an inflammatory process.