HELLP综合征期待治疗时间的探讨

目的：探讨妊娠＜34周的HELLP综合征患者终止妊娠时机。方法：选取51例＜34周产前HELLP 综合征患者为研究对象，根据诊断至终止妊娠时间分为期待≥48 h组（确诊后≥48 h终止妊娠）22例、期待＜48 h组（确诊后＜48 h终止妊娠）29例；每组再分为完全性和部分性2个亚组：完全性-期待≥48 h组9例，部分性-期待≥48 h组13例，完全性-期待＜48 h组21例，部分性-期待＜48 h组8例。比较各组一般情况、母儿情况、激素及血制品使用情况、疾病高峰期及恢复期主要实验室指标。结果：各组及亚组患者的一般情况、激素及血制品使用、产后住院时间、最低血小板恢复正常时间、产后出血情况、母体损害累计数、出院前疾病恢复期实验室指标，差异均无统计学意义。胎儿不良结局发生率，期待≥48 h组低于期待＜48 h组，部分性-期待≥48 h组低于部分性-期待＜48 h组（均P＜0.05）；而在完全性-期待≥48 h组和完全性-期待＜48 h组间相似（P＞0.05）。分娩前疾病高峰期，各组及亚组血红蛋白最低值、谷丙转氨酶（ALT）及谷草转氨酶（AST）最高值无明显差异。分娩前最低血小板值，期待＜48 h组低于期待≥48 h组，完全性-期待＜48 h组低于完全性-期待≥48 h组（均P＜0.05）；而部分性-期待＜48 h组和部分性-期待≥48 h组间比较差异无统计学意义（P＞0.05）。乳酸脱氢酶（LDH）最高值，期待＜48 h组高于期待≥48 h组，完全性-期待＜48 h组高于完全性-期待≥48 h组（均P＜0.05）；部分性-期待＜48 h组和部分性-期待≥48 h组间比较差异无统计学意义（P＞0.05）。结论：妊娠＜34周病情平稳的HELLP综合征患者尤其是部分性HELLP，密切监护母儿情况下，适当期待治疗超过48 h，能在一定程度上改善胎儿预后且不增加母体损伤风险。

Study on the Expectant Management Time of HELLP Syndrome

Objective：To investigate the timing of termination of pregnancy in ＜34 weeks′ gestation with HELLP syndrome. Methods：Retrospective study was applied to analyze 51 cases of pregnancy in ＜34 weeks′ gestation with HELLP syndrome. According to the time from diagnosis to termination of pregnancy, the cases were divided into two groups. One group consisted of 29 cases with termination of pregnancy within 48 hours after diagnosis (expectant management ＜48 h group), while the other group consisted of 22 cases with expectant management ≥48 h. The cases was further divided into four subgroups according to the Tennessee diagnostic criteria: complete expectant management (CEM)＜48 h group (21 cases), complete expectant management(CEM) ≥48 h group (9 cases), partial expectant management (PEM) ＜48 h group (8 cases), and partial expectant management (PEM) ≥48 h group (13 cases). The indexes including general condition, mother and fetus condition, use of hormones and blood products, and main laboratory indexes in peak period and recovery period of HELLP cases in CEM＜48 h group, CEM ≥48 h group, PEM＜48 h group and PEM≥48 h group was compared. Results：There was no difference in general condition, use of hormones and blood products, and main laboratory indexes in recovery period. There were also no significant differences in postpartum hospital days, the minimum platelet recovery time, the amount and rate of postpartum hemorrhage, as well as the cumulative number of maternal damage. The incidence of fetal adverse outcomes in CEM≥48 h group was significantly lower than that in CEM＜48 h group (P＜0.05), which in PEM≥48 h group was also lower than that in PEM＜48 h group (P＜0.05); however, that in CEM≥48 h group showed no differences with CEM＜48 h group (P＞0.05). No significant difference was found between the lowest hemoglobin and the highest AST/ALT between the groups and subgroups in peak period of disease. The lowest platelet in EM and CEM＜48 h groups was lower than that in EM and CEM≥48 h groups (P＜0.05), but not found between PEM＜48 h group and PEM≥48 h group (P＞0.05). The highest LDH in EM＜48 h group were higher than that in CEM≥48 h group (P＜0.01), which in CEM＜48 h group were lower than that in CEM≥48 h group (P＜0.01); however, no differences were found between PEM＜48 h group and PEM≥48 h group (P＞0.05). Conclusions：For patients with HELLP syndrome at the gestational age of ＜34 weeks, especially partial HELLP syndrome, if the condition is stable, closely observing the condition of the mother and fetus, and expectant treatment over 48 h does not significantly increase the risk of maternal injury and can improve the prognosis of the fetus.