妊娠合并血小板减少144例分析

目的:分析妊娠合并血小板减少患者影响母儿预后的因素及改善预后的措施。方法:回顾性分析1993~2003年我院妊娠合并血小板减少的144例患者的临床资料。诊断标准为孕期两次血小板<100×109/L。结果:妊娠合并血小板减少患者中特发性血小板减少者最多,占61.1%,其次为合并妊高征者(17.4%)和特发性血小板减少性紫癜(ITP)(11.1%);各组之间发生产后出血的量无显著差异;分娩前血小板水平<50×109/L的27例孕产妇中,有8例为经阴道分娩,19例剖宫产分娩,其中2例采用全麻,1例采用连续硬膜外麻醉,7例腰麻,9例腰麻加连续硬膜外麻醉,术后未出现硬膜外血肿等并发症。在围分娩期静脉应用地塞米松20 mg/d组分娩后血小板水平显著高于10 mg/d组(P<0.05)。结论:在围分娩期静脉应用地塞米松20 mg/d,有助于血小板水平的提高。在分娩前孕妇的血小板水平<20×109/L或伴有自发出血倾向,或胎儿血小板水平<50×109/L时,应首选剖宫产分娩,对于分娩前的血小板水平在(20~30)×109/L的产妇,可根据胎儿的大小、产妇宫颈b ishop评分等选择分娩方式,放宽剖宫产指征。血小板水平<50×109/L时,可在积极治疗血小板减少的前提下采用腰麻。

Clinical analysis of 144 cases of gestational thrombocytopenia

Objective:To investigate the prognosis and the prenatal treatments of gestational thrombocytopenia.Methods:The clinical data of 144 patients with gestational thrombocytopenia in Peking University First Hospital during 1993 to 2003 were retrospectively analyzed.The diagnosis of gestational thrombocytopenia was the maternal blood platelet counts lower than 100×10~9/L twice in pregnancy.Results:In 144 patients,the incidence of gestational idiopathic thrombocytopenia was 61.1%,thrombocytopenia with pregnancy hypertension 17.4%,idiopathic thrombocytopenia purpura 11.1%.There was no difference of postpartum hemorrhage among those groups.27 mothers' platelets were lower than 50×10~9/L before delivery,8 vaginal delivery,19 cesarean section in which 2 general anesthesia,17 intraspinal anesthesia.All cesarean section patients had no complications.The postpartum platelet counts of patients who used 20 mg dexamethasone every day in peridelivery days rise more rapidly than those who used 10 mg dexamethasone every day(P<0.05).Conclusion:To use 20 mg dexamethasone every day in peridelivery days may help patient's postparturm platelet counts raise.Cesarean section maybe the first choice when mother's platelet counts below 20 × 10~9/L or fetal platelet counts below 50× 10~9/L.When patient's platelet counts was in 20 ×10~9~30× 10~9/L,delivery way should be chosen according to fetal body weight,mother's cervical indication and so on.Luminal anesthesia can be selected when mother's platelet counts below 50×10~9/L if proper treatments were used.