产后应用血浆置换治疗HELLP综合征30例临床效果及微循环变化

目的观察产后应用血浆置换（TPE）治疗HELLP综合征的临床效果及微循环变化。方法30例HELLP综合征患者，产后常规治疗48h效果不佳，病情迁延，应用TPE进行治疗，TPE前后观测甲襞微循环变化。观察临床疗效，应用，检验对微循环参数变化进行统计学分析。结果30例HELLP综合征患者治愈出院26例，死亡4例，死亡率为13．3％。健康存活的26例中，血小板计数在TPE后48～72h恢复正常，肝酶在TPE后1～2周恢复正常，血压在2～5d后恢复正常。患者甲襞微循环管襻形态、血液流态、襻周状态及总积分值均有改善（P〈0．05）。结论产后应用TPE可有效治疗病情迁延的HELLP综合征，纠正微循环障碍。

The Observation of Clinical Effects and Microcirculation Changes on 30 Patients with HELLP Syndrome Treated by Therapeutic Plasma Exchange After Delivery

Objective To observe the clinical effects and microcirculation changes of hemolysis ,elevated liver enzymes and low platelets （HELLP） syndrome treated by therapeutic plasma exchange （TPE） after delivery.Methods Thirty patients with HELLP syndrome treated by routine therapy over 48 hours after delivery,whose clinical effects were bad,were treated by TPE.Clinical effects and microcircular parameters were observed before and after TPE, statistical difference by t test was analysed.Results Twenty-six cases were cured,and four cases died,the mortality were 13.3%.The shape of vascular loop,the velocity of blood flow,the state around vessel and total integral value showed significant depression（P〈0.05）.Conclusion TPE after delivery for HELLP syndrome could achieve better clinical effects and correct abnormality in microcirculation.It is a good method for the treatment of HELLP syndrome.