妊娠期高血压疾病并发HELLP综合征12例临床分析

目的探讨和分析妊娠期高血压疾病并发HELLP综合征的诊断、治疗及预后。方法对我院5年来妊娠期高血压疾病并发HELLP综合征12例患者的临床资料进行回顾性分析。结果HELLP综合征在重度妊高征患者中的发病率为8．3％，参考Sibai的诊断标准，Ⅰ型HELLP综合征7例，Ⅱ型HELLP综合征5例。治疗方法为在严密监护母儿情况下积极治疗妊高征，早期使用糖皮质激素，尽快终止妊娠。结论早期诊断、综合性治疗、适时终止妊娠，可改善HELLP综合征患者的预后。     

HELLP综合征9例临床分析

目的:分析9例HELLP综合征的临床特点,探讨该病的诊断和治疗方法.方法:时9例HELLP综合征患者的临床资料进行回顾性分析.结果:9例HELLP综合征发病孕周为28～39周,终止妊娠孕周为33.09±3.70周,均采用剖宫产;完全性HELLP 4例,部分性HELLP 5例.完全性HELLP组血小板计数值明显低于部分性HELLP组(P<0.05);孕产妇严重并发症有:多脏器衰竭、DIC和感染性休克1例,胎盘早剥3例,产后出血3例;新生儿早产9例,重度窒息4例,新生儿死亡1例.结论:HELLP综合征是一种严重的产科并发症,尤其是完全性HELLP综合征的患者,一旦诊断,终止妊娠是治疗最有效的措施.     

妊娠期高血压疾病并发HELLP综合征29例临床分析

目的分析妊娠期高血压疾病并发HELLP综合征的临床表现及对母儿的影响,探讨有效的诊断和治疗方法.方法 1996年1月至2004年3月中山市人民医院采用回顾性分析方法,对29例Ⅰ型和Ⅱ型HELLP综合征的临床资料进行分析,对比两组患者的临床表现、母儿并发症和分娩结局.结果Ⅰ型HELLP组的重度子疒间前期和子疒间发生率为94.7%,明显高于Ⅱ型HELLP组(50.0%)(P<0.05);Ⅰ型HELLP组出现特殊表现者占68.4%,亦高于Ⅱ型HELLP组(30.0%)(P<0.05);Ⅰ型HELLP组围生儿死亡率31.6%,Ⅱ型HELLP组围生儿死亡率10.0%,两组比较差异有显著性意义(P<0.05);两组间产妇并发症、剖宫产率比较差异无显著性意义(P>0.05).两组患者血小板值产后72h恢复正常.结论早期诊断、综合性治疗、适时终止妊娠,可改善HELLP综合征患者的预后.     

妊娠高血压疾病合并HELLP综合征8例临床分析

目的:探讨妊娠期高血压疾病并发溶血、肝酶升高、血小板减少(HELLP)综合征的发病率、诊断、治疗和预后。方法:对我院2年来HELLP综合征8例患者的临床资料进行回顾性分析。结果:HELLP综合征占同期妊娠期高血压疾病的6.96%,其主要并发症为DIC,上消化道出血,胎盘早剥,胎儿生长受限等。在严密监护母儿情况下治疗妊娠期高血压疾病,早期应用糖皮质激素,尽早终止妊娠,本资料中8例患者均痊愈出院,围生儿死亡率为37.5%(3/8)。结论:HELLP综合征是妊娠期高血压疾病严重威胁母儿安全的并发症,及早发现并应用糖皮质激素治疗,可以降低母儿死亡率。     

重度妊娠高血压综合征并发HELLP综合征病例分析

1病历摘要患者29岁,住院号990524。因停经39周,尿色变红2天,不规律下腹痛伴少量阴道流血1天,上腹部剧痛3小时入院。平素月经规律,末次月经1998年7月24日,预产期1999年5月1日。1个月前出现双下肢水肿,无头晕、眼花等症状,血压正常。既往健康。查体：T36．2℃,P84／min,R16／min,BP25／15kPa。无贫血貌,心肺听诊无异常,宫缩不规律,胎心142／min,双下肢水肿（＋＋）。B超提示：单胎头位,羊水偏少。实验室检查：尿常规：肉眼血尿,蛋白（＋＋＋＋）,红细胞满视野。血常规：白细胞12．7x10'几,血红蛋白门og几,红细胞压积0…     

妊高征并发HELLP综合征5例临床分析

妊高征患者并发溶血 (ｈｅｍｏｌｙｓｉｓ)、肝细胞酶升高 (ｅｌｅｖａｔｅｄｌｉｖｅｒｅｎｚｙｍｅｓ)和血小板减少 (ｌｏｗｐｌａｔｅｌｅｔｓ)称为ＨＥＬＬＰ综合征 ,母婴病死率较高。如能早期识别 ,及时治疗 ,适时终止妊娠 ,可减少母婴病死率。我院 1988年 7月至 2 0 0 0年 12月共收治妊高征并发ＨＥＬＬＰ综合征 5例 ,现报告如下。1　临床资料1.1　一般资料　患者 2 5～ 40岁 ,孕龄 2 7～ 39周 ,平均 33周 ;初产妇 4例 ,经产妇 1例 ,其中高龄初产 1例 ,均为单胎。重度妊高征 4例 ,先兆子痫 1例。血压 2 0～ 2 6 / 15～ 17ｋＰａ ,尿蛋…     

妊高征并发HELLP综合征7例分析

ＨＥＬＬＰ综合征是一组表现溶血 (ｈｅｍｏｌｙｓｉｓ)、肝酶升高(ｅｌｅｖａｔｅｄｌｉｖｅｒｅｎｚｙｍｅｓ)和血小板减少 (ｌｏｗ ｐｌａｔｅｌｅｔｓ)的综合征 ,是重度妊高征的严重并发症 ,母婴病死率较高。我院1992年 6月至 2 0 0 0年 3月收治妊高征并发ＨＥＬＬＰ综合征 7例 ,现报告如下。1　临床资料1.1　一般资料　本文 7例年龄为 2 2～ 36岁 ,平均 2 7岁 ;孕龄 32～ 40周 ,平均 36 4 周 ;初产妇 5例 ,经产妇 2例。临床表现为 :①妊高征 7例 ,均有水肿 ,其中重度水肿 4例 ;重度高血压 4例 ,轻度高血压 3例 ;6例蛋白尿 ,1例尿蛋白…     

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。     

妊高征并发HELLP综合征

ＨＥＬＬＰ综合征是妊高征的严重并发症，其特点是血管内溶血、肝酶升高，血小板减少。易与非产科疾病混淆，具有较高的孕妇及围产儿病率和死亡率。本文就近年来对此病的病理生理、临床表现，临床过程，诊断标准和处理等方面进行了综述，以期提高对此病的认识。     

HELLP综合征14例临床分析

目的 探讨产科并发症HELLP综合征的母儿预后。方法 回顾性分析研究14例HELLP综合征的患者妊娠结局和围产儿预后。结果 14例中12例发生在产前，2例发生在产后，平均孕龄为32．5周，孕妇的严重并发症包括：急性肾衰、DIC、肺水肿、严重腹水和胎盘早剥等。其中8例需要输血或血液制品，12例采用剖宫产结束分娩。围产儿死亡5例，主要与胎盘早剥有关，另外胎儿宫内窘迫及早产也是重要原因。结论 HELLP综合征是一种严重的产科并发症，其高的母婴并发症和病死率要求我们对有妊娠高血压疾病的患者进行密切随访和治疗，一旦确诊为HELLP综合征应转入中心级以上医院进行治疗，尽快终止妊娠。     

HELLP综合征30例临床分析

目的分析30例HELLP综合征的临床表现及母儿结局,探讨该病目前的诊治和预后. 方法对30例HELLP综合征进行回顾性分析,其中完全性HELLP 19例,部分性HELLP 11例,比较两组的实验室指标、临床表现、母儿并发症和分娩结局. 结果完全性HELLP组的乳酸脱氢酶值为(622±481)U/L,显著高于部分性组(369±101)U/L(P<0.05);而其他各实验室指标两组间无统计学差异.完全性HELLP组中、重度妊高征占84%(16/19),有特殊表现病例占63%(12/19),部分性HELLP组中、重度占36%(4/11),有特殊表现病例占18%(2/11),两组有显著性差异(P<0.05).两组围产儿死亡率无统计学差异(完全性组20.0%,部分性组9.1%,P>0.05).完全性HELLP组的分娩孕周为(32±4)周,新生儿体重(1617±603) g;部分性组的分娩孕周为(36±3)周,新生儿体重(2381±786) g,两组比较差异有显著性(P均<0.05).两组剖宫产率为95%(完全性组)和73%(部分性组),差异无显著性(P>0.05).产后HELLP综合征者2例,均为完全性.两组患者的血小板和肝功能均于产后24 h开始恢复,产后72 h血小板恢复正常,产后第5天肝功能恢复正常. 结论完全性HELLP综合征的临床病情较部分性更加严重.但如能及时诊治,二者的预后(包括实验室指标的恢复和围产儿死亡率)无显著差别.     

Factors contributing to adverse maternal outcomes in patients with HELLP syndrome

Objective: To determine the prognostic factors for adverse maternal outcomes in women with complete HELLP syndrome.

Methods: A retrospective cohort study was carried out by searching the hospital data for the diagnosis of HELLP syndrome according to Tennessee classification from January 2007 to January 2014. Data included a total of 171 patients between January 2007 and January 2014. The data were collected from the hospital records including demographic data variables, presence of preeclampsia/chronic hypertension, gestational age at the time of diagnosis, and adverse maternal outcomes in terms of eclampsia, disseminated intravascular coagulopathy, acute renal failure (ARF), pulmonary edema, abruptio placentae placental abruption, pleural effusion, ascites, transfusion, and death were determined as adverse maternal outcomes. Independent prognostic factors for each complication with adverse maternal outcome were determined.

Results: A total of 171 patients between January 2007 and January 2014 were included in the study. Clinical and laboratory parameters of 171 patients were analyzed. Risk factors for adverse maternal outcomes were as follows; aspartate amino transferase (AST)?>?316?U/L, alanine aminotransferase (ALT)?>?217?U/L, total bilirubin >2.0?mg/dL, lactate dehydrogenase (LDH)?>?1290?U/L, blood urea nitrogen (BUN)?>?44?mg/dL, and low platelets (<50,000/mm³). The risk of eclampsia increased 4.1 times and 3.4 times in the presence of LDH >1290?U/L and headache, respectively. Younger maternal age also increased the risk of eclampsia. Risk of ARF increased 15 times at the levels of bilirubin >2.0.

Conclusions: Younger age, headache, bilirubin >2.0?mg/dL, LDH >1290?U/L, and low platelets (<50,000/mm³) were independent prognostic risk factors for predicting adverse maternal outcomes.     

The Maternal Benefits of Corticosteroids with HELLP (Hemolysis,Elevated Liver Enzymes,Low Platelet Count) Syndrome

Objectives: To determine the more effective regime in improving hematologic abnormalities associated with HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, by comparing two different antenatal dosing protocols for dexamethasone (given primarily for fetal lung maturity).Study Design: A retrospective cohort study of 30 women between 24 and 34 weeks’ gestation, diagnosed with HELLP syndrome prior to delivery, who received 2 doses of dexamethasone 12 mg intramuscularly, given either 24 hours apart or 12 hours apart.Results: There was a shorter time from the first corticosteroid dose to the beginning of improvement with the 12-hour regime for platelet count (11 hours [9, 25 hours] versus 69 hours [41, 112 hours], median [quartiles], P = 0.003) and for alkaline phosphatase (25 hours [5, 44 hours] versus 59 hours [31, 69 hours], median [quartiles], P = 0.02). Worsening recurred from 11 hours, for alanine aminotransferase (ALT) and aspartate transaminase (AST), to 32 hours, for uric acid, after initial improvement. Hematologic improvement occurred in 37% (for ALT) to 67% (for alkaline phosphatase) of women overall.Conclusion: A temporary improvement in the hematologic parameters of HELLP syndrome can occur with antenatal dexa-methasone administration, with the 12-hour regime having quicker onset to improvement in platelet count and alkaline phosphatase.     

HELLP syndrome in pregnancies below 26th week

Objective: To test the hypothesis that HELLP syndrome may be more likely to develop earlier, if a pregnant woman has aPL antibodies, and to observe clinical and laboratory factors preceding the occurrence of HELLP syndrome. Materials and methods: The study consisted in retrospective analysis, with updated verification, of HELLP syndrome in pregnancies below 26th week in our clinic in the years 1992–2010. Results: HELLP syndrome, if it occurred before the 26th week, occurred only in women with preeclampsia superimposed on chronic hypertension and in women with aPL antibodies. HELLP syndrome with aPL antibodies occurred with low level of platelets (mean 35.5?×?10⁹/L), lower level of AT III (mean 71.3%), lymphopenia, higher CRP (mean 9.1) and pale infarct of placenta (100%). The occurrence of HELLP syndrome was always preceded by surges in blood pressure resistant to antihypertensive drugs. Conclusion: HELLP syndrome in early pregnancy may indicate the presence of aPL antibodies. It may also be a clinical symptom of APS. A surge in blood pressure is a clinical forerunner of the coming HELLP syndrome. HELLP syndrome in women with APS is characterized by low level of platelets.     

单胎妊娠重度子痫前期并发HELLP综合征26例临床分析

目的探讨重度子痫前期并发HELLP综合征对母儿结局的影响。方法 2008年10月至2011年10月北京大学人民医院收治重度子痫前期121例（双胎妊娠12例,单胎109例）,其中重度子痫前期并发HELLP综合征31例（双胎妊娠5例,单胎妊娠26例）,将26例单胎妊娠并发HELLP综合征患者为HELLP组;重度子痫前期未并发HELLP综合征90例（双胎妊娠7例,单胎妊娠83例）,将83例单胎妊娠未并发HELLP综合征患者为对照组。回顾性分析HELLP组和对照组孕妇的母儿结局。结果 HELLP组中最高舒张压、确诊孕周和终止妊娠孕周分别为（109.62±19.23）mm Hg、（32.02±4.50）周和（32.18±4.93）周,对照组分别为（99.14±11.70）mm Hg、（35.25±3.88）周和（35.66±3.69）周,两组比较,差异均有统计学意义（P〈0.05）。HELLP组期待治疗时间（1.38±2.62）d与对照组（2.49±3.46）d比较,差异无统计学意义（P〉0.05）,HELLP组剖宫产率（57.69%,15/26）与对照组（81.93%,68/83）比较,差异有统计学意义（P〈0.05）。两组尿蛋白、使用硫酸镁剂量比较,差异均无统计学意义（P〉0.05）。HELLP组使用静脉降压药物、眼底痉挛渗出、多浆膜腔积液及低氧血症发生率分别为34.62%（9/26）、46.15%（12/26）、65.38%（17/26）和19.23%（5/26）,对照组分别为3.61%（3/83）、13.25%（11/83）、10.84%（9/83）和3.61%（3/83）,两组比较,差异均有统计学意义（P〈0.05）。HELLP组新生儿体质量[（1751.80±1027.13）g]与对照组[（2474.20±946.61）g]比较,差异有统计学意义（P〈0.05）。HELLP组孕产妇死亡1例;死儿丢失11例;对照组未发生孕妇死亡,发生死儿丢失11例。结论重度子痫前期并发HELLP综合征是病情危重的表现,其发病孕周较早,影响胎盘功能可致胎儿发育受限及死胎,严重影响胎儿结局。母体并发多浆膜腔积液及低氧血症比例高于未并发HELLP综合征患者。经积极的救治和处理可争取较好     

HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) presenting as generalized malaise

The syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP) was first described by Weinstein in 1982 and is generally thought to represent a variant of the preeclampsia-eclampsia syndrome. As with other severe manifestations of preeclampsia-eclampsia, epigastric pain and liver tenderness are commonly recognized presenting symptoms of this syndrome, but an underappreciated presenting symptom is generalized malaise or symptoms similar to a flulike syndrome. Two case examples, a review of one private hospital's recent cases, and data contained in the literature are presented to stress the importance of malaise as a presenting complaint during late pregnancy, with recommendations for screening these patients.     

Dexamethasone compared with betamethasone for glucocorticoid treatment of postpartum HELLP syndrome

Objectives: To compare the efficacy of dexamethasone and betamethasone to ameliorate the course of postpartum hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. Methods: A prospective, mixed randomized/non-randomized clinical investigation of patients with postpartum HELLP syndrome. Treatment with either dexamethasone or betamethasone was continued until there was evidence of disease recovery. Results: Baseline characteristics of both the dexamethasone (n=18) and betamethasone (n=18) groups were similar. Although the time to discharge from the obstetrical recovery room was not statistically significant between groups, reduction in mean arterial blood pressure was more pronounced in the dexamethasone group as compared with the betamethasone group (−15.3±1.4 mmHg vs. −7.5±1.4 mmHg, respectively, P<0.01). Patients in the dexamethasone group required less antihypertensive treatment than the betamethasone group (6% vs. 50%, P=0.01) and also had a decreased need for readmission to the obstetrical recovery room (0% vs. 22%, P=0.03). Conclusion: This investigation supports the use of dexamethasone as the superior glucocorticoid to use for patients with postpartum HELLP syndrome.