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目的:分析妊娠期高血压疾病并发HELLP综合征的临床表现和母儿结局,探讨有效的诊断和治疗方法。方法:对32例HELLP综合征患者的临床资料进行回顾性分析,其中完全性HELLP综合征18例,部分性HELLP综合征14例;Ⅰ型10例,Ⅱ型22例;比较各组的实验室指标、临床表现、母儿并发症及围产儿结局。结果:完全性HELLP组及Ⅰ型HELLP组的血小板、肝酶、胆红素等指标均高于部分性HELLP组及Ⅱ型组,尤其是LDH值,差异具有统计学意义(P<0.05)。产妇的并发症包括DIC、急性左心衰、急性肾衰、胎盘早剥、重度贫血、产后出血、腹水、心包胸腔积液,完全性HELLP组与部分性组在产妇并发症方面比较差异有统计学意义(P<0.05),Ⅰ型组与Ⅱ型组产妇并发症比较差异也有统计学意义。完全性HELLP组围产儿死亡率38.9%,部分性组围产儿死亡率为14.3%,两组比较差异有统计学意义(P<0.05)。Ⅰ型组与Ⅱ型组围产儿死亡率分别为50%及18.2%,两组比较差异有统计学意义。结论:完全性HELLP综合征及Ⅰ型HELLP综合征的临床病情较部分性及Ⅱ型更加严重,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。
Objective: To analyze the clinical manifestations and maternal and child outcomes of Hypertensive disorder complicated with HELLP syndrome in pregnancy, and to explore effective methods of diagnosis and treatment. Methods: The clinical data of 32 patients with HELLP syndrome were analyzed retrospectively, including 18 complete HELLP syndromes, 14 partial HELLP syndromes, 10 type I cases and 22 type II cases. Indicators, clinical manifestations, complications of mother and child and perinatal outcome. Results: The indexes of platelet, liver enzyme and bilirubin in complete HELLP group and type Ⅰ HELLP group were higher than those in partial HELLP group and type Ⅱ group, especially LDH value, the difference was statistically significant (P <0.05). Maternal complications include DIC, acute left heart failure, acute renal failure, placental abruption, severe anemia, postpartum hemorrhage, ascites, pericardial pleural effusion, complete HELLP group and partial group compared with maternal complications statistics Significance (P <0.05). There was also significant difference in the complication between type Ⅰ and type Ⅱ maternal complications. Perinatal mortality was 38.9% in the complete HELLP group and 14.3% in the partial sex group. There was significant difference between the two groups (P <0.05). The perinatal mortality rates in type I group and type II group were 50% and 18.2% respectively, with significant difference between the two groups. Conclusion: The clinical manifestations of complete HELLP syndrome and type Ⅰ HELLP syndrome are more serious than those of type Ⅱ. Early diagnosis and comprehensive treatment and timely termination of pregnancy may improve the prognosis of patients with HELLP syndrome.