Pregnancy complicated by preeclampsia-eclampsia with the syndrome of hemolysis, elevated liver enzymes, and low platelet count: how rapid is postpartum recovery?
Pregnancy complicated by preeclampsia-eclampsia with the syndrome of hemolysis, elevated liver enzymes, and low platelet count: how rapid is postpartum recovery?
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妊娠并发子痫前期-子痫并伴有溶血、肝酶升高和血小板计数低综合征：产后恢复速度有多快？
DOI：
10.1097/00006250-199011000-00001
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发表时间：
1990
影响因子：
7.2
通讯作者：
J. C. Morrison
中科院分区：
文献类型：
--
作者：
J. Martin;P. Blake;S. L. Lowry;K. G. Perry;J. Files;J. C. Morrison
严重先兆子痫合并溶血、肝酶升高和血小板减少(HELLP综合征)的产后疾病恢复速度尚未得到很好的研究。1980年1月至1989年3月，密西西比大学医学中心对158例子痫前期-子痫合并HELLP综合征孕妇进行了治疗。70例血小板最低值低于50,000/微L的患者(1类HELLP综合征)需要11天的时间才能使所有成员的血小板恢复浓度达到100,000/微L以上，而所有88例血小板最低值在50,000-100,000/微L之间的孕妇(2类HELLP综合征)在产后第6天超过这一水平，差异有统计学意义(P<0.0001)。从分娩到开始利尿的时间(平均+/-SD)1级患者明显长于2级患者(22.7±18.9比15.9+/-11.1小时)。1组产妇产后乳酸脱氢酶浓度降至500IU/L以下所需天数明显多于2组(4.2±-4.9天比3.2±2.7天)。2级组中没有女性需要血浆交换治疗来阻止和逆转疾病，但1级中58名病情严重的女性中有11名接受了这种治疗。我们的结论是，血小板计数和LDH血清浓度作为HELLP严重程度和恢复的指标，是临床上有用的工具，对于HELLP综合征的渐进性重度表达，产后恢复期应该更长。
The rapidity of postpartum disease recovery for severe preeclampsia associated with hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome) has not been well studied. Between January 1980 and March 1989, 158 pregnancies with preeclampsia-eclampsia complicated by HELLP syndrome were managed at the University of Mississippi Medical Center. The 70 patients with platelet nadir below 50,000/microL (class 1 HELLP syndrome) required as long as 11 days for all members to achieve a platelet recovery concentration of more than 100,000/microL, whereas all 88 gravidas with platelet nadir between 50,000-100,000/microL (class 2 HELLP syndrome) exceeded this platelet concentration by the sixth postpartum day, a statistically significant difference (P less than .0001). The interval between delivery and the onset of diuresis (mean +/- SD) was significantly longer in class 1 than in class 2 patients with milder disease (22.7 +/- 18.9 compared with 15.9 +/- 11.1 hours). Significantly more postpartum days were required in class 1 than in class 2 HELLP parturients for the lactic dehydrogenase (LDH) concentration to decrease below 500 IU/L (4.2 +/- 4.9 compared with 3.2 +/- 2.7 days). No women in the class 2 group required plasma exchange therapy to effect disease arrest and reversal, but 11 of 58 severely ill women in class 1 were treated with this modality. We conclude that the platelet count and LDH serum concentration, as indicators of HELLP severity and recovery, are clinically useful tools and that a more protracted postpartum recovery period should be expected for progressively severe expressions of HELLP syndrome.