妊娠期高血压疾病并发HELLP综合征终止妊娠时机及方式的探讨

目的:探讨妊娠期高血压疾病并发溶血、肝酶升高及血小板减少综合征(HELLP综合征)终止妊娠的时机和方式对母儿的影响。方法:对我院11年来31例HELLP综合征患者的临床资料进行回顾性分析。结果:31例患者当中阴道分娩仅2例,其中1例母体产后并发DIC死亡,围生儿1例死产,1例新生儿死亡。剖宫产29例,剖宫产率93.5%,其中1例母体术后并发急性肾功能衰竭死亡,1例术后并发DIC、多器官衰竭(MOST)死亡,余27例均存活,未发现明显后遗症;围生儿31例(双胎2例),其中胎死宫内3例,死产1例,新生儿死亡4例。结论:HELLP综合征严重威胁母儿的安全,适时终止妊娠是治疗HELLP综合征极其重要的手段,终止妊娠的方式首选剖宫产;终止妊娠的时机为诊断后24~48小时,具体还应依病情的严重程度及孕周的大小作出综合判断。

Opportunity and Method of Pregnant Termination in PIH Patients with HELLP

Objective: To investigate the relationship between the optimal time and method of pregnancy termination and maternal and perinatal fetus prognosis in pregnancy induced hypertension (PIH) patients with hemolysis, elevated liver enzymes, and low platelets syndrome (HELLP syndrome). Methods: Retrospective analyses were done on 31 patients with HELLP syndrome in latest 11 years. Results: In these 31 patients, only 2 had vaginal deliveries with one mother died of DIC, one stillbirth, and one newborn death. 29 patients underwent cesarean sections (93.6%). Among them, there were two mother death, one with acute renal failure, another one died of DIC and MOF; Others 27 survival without obvious sequelae. For the 31 perinatal fetus (including two twins), 3 dead fetus in uterus, one stillborn, and 4 neonatal death. Conclusions: HELLP syndrome is dangerous to mother and perinatal fetus. Timely terminating pregnancy is one of the most important treatment methods for HELLP, and cesarean section is the first choice. The operation time is between 24 to 48 hours after diagnosis, based on the synthetic judgment on severity of disease and gestational weeks of patients.