HELLP综合征合并多器官功能障碍综合征的临床治疗

目的分析HELLP综合征合并多器官功能障碍综合征（MODS）的临床特点,探讨该疾患的诊治。方法对2008年1月-2010年1月期间重症监护病房（ICU）收治的7例HELLP综合征合并MODS病人在实验室指标、临床症状以及ICU治疗等方面进行回顾性分析。结果 7例患者均伴有不同程度的妊高征表现,在诊断明确后终止妊娠,经ICU综合治疗后肝肾功能恢复、生命体征平稳,病情好转后转入普通病房;7例患者除出现肝、肾功能损害外,均伴有血小板减少、脑利钠肽和D-二聚体增高;其中出现腹部疼痛并伴有恶心、呕吐5例;有头疼、视物模糊4例,出现晕厥1例;因呼吸困难、氧合指数低行机械通气治疗4例。结论 HELLP综合征合并MODS是一种严重的产科并发症,应早期终止妊娠,ICU综合治疗能提高救治成功率。

Clinical treatment of hemolysis, elevated liver enzymes, and low platelets syndrome accompanying multiple organ dysfunction syndrome

Objective To analyze the clinical characteristics of hemolysis, elevated liver enzymes and low platelets（HELLP） syndrome accompanying multiple organ dysfunction syndrome（MODS） and study its diagnosis and treatment. Methods Laboratory data, clinical symptoms and treatment of 7 patients with HELLP syndrome accompanying MODS admitted to intensive care unit（ICU） in January 2008-January 2010 were retrospectively analyzed. Results All the patients had different clinical symptoms of pregnancy hypertension. The pregnancy was terminated when they were diagnosed as HELLP syndrome. The patients were transferred from ICU to general wards when their liver and renal function was recovered and their vital signs became stable. Besides liver and renal function impairment, the patients suffered from thrombocytopenia and elevated brain natriuretic peptide（BNP） and D-dimer level. Of the 7 patients, 5 had abdominal pain accompanying nausea and vomiting, 4 had headache and blurred vision, 1 had apopsychia, 4 underwent ventilation due to dyspnea and insufficient oxygenation. Conclusion HELLP syndrome accompanying MODS syndrome is a severe complication of pregnant women. Pregnancy should be terminated as early as possible and comprehensive treatment should be considered in ICU for it.