2019 年第 9 期 第 14 卷

HELLP综合征临床分析

Clinical analysis of HELLP syndrome

作者：姬建秀陈燕白惠王蕊

英文作者：

单位：063000河北省唐山市协和医院妇产科（姬建秀、白惠、王蕊）；063000河北省唐山市，华北理工大学附属医院妇产科（陈燕）

英文单位：

关键词：HELLP综合征；相关因素；母婴结局

英文关键词：

• 摘要：

• 【摘要】目的    探讨HELLP综合征患者的临床特征、发病相关因素、治疗方法和母婴结局。方法    回顾分析2013年1月至2018年12月唐山市协和医院收治的15例HELLP综合征患者的临床资料。分析其一般情况、实验室检查指标、母婴结局。结果    妊娠合并慢性高血压并发HELLP综合征5例，妊娠合并系统性红斑狼疮并发HELLP综合征1例，妊娠合并肾病综合症并发HELLP综合征3例，妊娠合并抗磷脂综合征并发HELLP综合征3例，原因不明 3例。产前HELLP综合征10例，产后HELLP综合征5例。临床表现：15例患者血压和转氨酶均升高；全身水肿，体质量骤然增加4例；视物不清7例；头痛4例；上腹部不适5例；恶心、呕吐5例；双下肢无力2例。15例患者均给予硫酸镁解痉，尼卡地平静脉滴注降压治疗，6例患者给予激素治疗。15例患者中胎死宫内3例，胎儿生长受限3例。引产4例，剖宫产11例。无孕产妇死亡。1例患者产后转入风湿免疫科继续治疗，另外14例患者于术后7～11 d出院，预后良好。结论    HELLP综合征病因复杂，临床表现多样，病情危重。早期识别，积极干预，可以有效降低母婴病死率，改善母婴预后。

• 【Abstract】Objective    To investigate the clinical characteristics, risk factors, therapeutic measures, maternal and fetal outcomes of HELLP syndrome. Methods    Clinical data of 15 patients with HELLP syndrome admitted to Tangshan Union Medical College Hospital from January 2013 to December 2018 were retrospectively analyzed. General data, laboratory indicators, maternal and fetal outcomes were analyzed. Results    There were 5 cases of pregnancy with chronic hypertension, 1 case of pregnancy with systemic lupus erythematosus, 3 cases of pregnancy with nephrosis syndrome, 3 cases of pregnancy with antiphospholipid syndrome and 3 cases of unexplained HELLP syndrome. There were 10 cases of prenatal HELLP syndrome and 5 cases of postpartum HELLP syndrome. Clinical manifestations included elevated blood pressure and aminotransferase(15 cases), systemic edema and sudden weight gain(4 cases), visual disturbance(7 cases), headache(4 cases), upper abdominal discomfort(5 cases), nausea and vomiting(5 cases) and lower limb weakness(2 cases). Fifteen patients were treated with magnesium sulfate and nicardipine. Six patients were treated with glucocorticoids. Three fetuses died in uterus and 3 fetuses suffered from intrauterine distress. Four patients had induced labour and 11 patients had cesarean section. No maternal death occurred. One patient was admitted to Department of Rheumatology and Immunology after delivery; 14 patients recovered well and discharged in 7-11 days. Conclusions    HELLP syndrome is a severe illness with complex causes and various clinical manifestations. Early identification and active intervention can reduce maternal and fetal mortality and improve the prognosis.