妊娠期急性脂肪肝病例分析及回顾

发布时间：2017-12-27 23:23

本文关键词：妊娠期急性脂肪肝病例分析及回顾　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:妊娠期急性脂肪肝是罕见且病死率高的产科疾病,其发病机制尚未明确。近年来随着对该病认识的提高,孕产妇死亡率和围生儿病死率显著降低。现通过对我院住院诊断为妊娠期急性脂肪肝的患者的诊治过程进行回顾性分析,总结治疗经验,为进一步提高母儿生存率提供依据。方法:回顾性分析2010年3月到2016年11月在吉林大学第一医院诊治的21例妊娠期急性脂肪肝患者的临床资料,根据妊娠结局分为生存组14例及死亡组7例,从临床表现、终止妊娠时间、终止妊娠方式、人工肝治疗及相关并发症等方面分析总结,从而得出积极的治疗方法。结果:(1)发病孕周:21例患者均于孕晚期发病,其中经产妇2例,初产妇19例;围产儿生存率54%。(2)临床症状:生存组中,黄疸6例,消化道症状8例;死亡组中,黄疸1例,消化道症状5例;两组在临床表现上比较无显著差异;(3)实验室指标:两组患者的凝血、肝、肾功能及其他实验室指标都存在不同程度异常,两组比较差异无明显性。(4)终止妊娠时间:自发病起7天内终止妊娠的患者生存率为81%,超过7天终止妊娠的患者生存率为20%,两组比较有差异性。(5)终止妊娠方式:生存组中5例经阴道分娩;9例行剖宫产术,其中3例行蛛网膜下腔阻滞麻醉,6例行全身麻醉;死亡组中2例经阴道分娩;5例行剖宫产术,其中1例行蛛网膜下腔阻滞麻醉,余4例行全身麻醉。在分娩方式及麻醉选择上,两组比较无显著差异。(6)人工肝时间及方式:生存组中5例行血液滤过,分别于分娩后第1-3天内进行,死亡组中6例行血液滤过,分别于分娩后第1-5天内进行;生存组中2例行血浆置换,均于发生肝性脑病后1天,死亡组中1例行血浆置换,于发生肝性脑病后4天。(7)并发症:生存组中患者存在并发症数量1-5个,死亡组中患者存在并发症数量4-8个。结论:提高基层医院医生对该病的认识能力,规范产前检查项目,尤其对于出现消化道症状的孕晚期患者,早期发现并诊断,及时终止妊娠,选择恰当的分娩方式和麻醉方法,术后给予重症监护,及时早应用人工肝治疗,补充血制品、凝血因子、白蛋白。针对各种并发症,积极对症治疗,从而可提高母儿生存率。
[Abstract]:Objective: acute fatty liver disease in pregnancy is a rare and highly fatality obstetric disease, and its pathogenesis is not yet clear. In recent years, with the improvement of the awareness of the disease, maternal mortality and perinatal mortality have decreased significantly. The diagnosis and treatment of acute fatty liver in pregnancy is retrospectively analyzed, and the treatment experience is summarized, so as to provide evidence for further improving the survival rate of mother and child. Methods: a retrospective analysis from March 2010 to November 2016 in No.1 Hospital of Jilin University clinical data of diagnosis and treatment of 21 cases with acute fatty liver of pregnancy, according to the outcome of pregnancy were divided into the survival group and death group 14 cases of 7 cases, the clinical manifestation, the time of termination of pregnancy, termination of pregnancy, artificial liver treatment and related complications were analyzed and summarized, so that active treatment. Results: (1) the onset of pregnancy: 21 cases were all in the late pregnancy, including 2 cases of maternal and 19 primipara; the perinatal survival rate was 54%. (2) clinical symptoms: survival group, 6 cases of jaundice, 8 cases of gastrointestinal symptoms; in the death group, 1 cases of jaundice, 5 cases of gastrointestinal symptoms; two groups on the clinical manifestation of no significant difference; (3) laboratory index: two groups of patients with blood, liver and kidney function and other laboratory there are different degrees of abnormal index, no significant difference between the two groups. (4) the time of termination of pregnancy: the survival rate of patients who terminated pregnancy within 7 days of onset was 81%. The survival rate of patients who terminated pregnancy more than 7 days was 20%, and there was a difference between two groups. (5) the pattern of terminating pregnancy: survival group 5 cases of vaginal delivery; 9 cases of cesarean section, including 3 cases of subarachnoid anesthesia, 6 cases underwent general anesthesia; the death group, 2 cases of vaginal delivery; 5 cases of cesarean section, including 1 cases of subarachnoid anesthesia, more than 4 patients with general anesthesia. There was no significant difference in the way of delivery and the choice of anesthesia in the two groups. (6) the time and manner of artificial liver: survival group 5 underwent hemofiltration, respectively in the 1-3 days after birth, death group 6 underwent hemofiltration, were carried out in the 1-5 days after delivery; 2 cases in survival group and plasma exchange were hepatic encephalopathy after 1 days, the death group in 1 cases of plasma exchange, in 4 days after the occurrence of hepatic encephalopathy. (7) complications: the number of complications in the survival group was 1-5, and the number of complications in the death group was 4-8. Conclusion: to improve the primary hospital doctor cognition of the disease, prenatal care project, especially for the occurrence of gastrointestinal symptoms in patients with late pregnancy, early detection and diagnosis, timely termination of pregnancy, select the appropriate delivery and anesthesia, postoperative intensive care, timely early application of artificial liver treatment, blood products, coagulation factor, albumin. In view of all kinds of complications, active symptomatic treatment can improve the survival rate of mother and child.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.255

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