妊娠合并中重度血小板减少60例临床分析

发布时间：2018-05-06 15:04

本文选题：妊娠 + 中重度血小板减少　；参考：《福建医科大学学报》2015年03期

【摘要】：目的探讨妊娠合并中重度血小板减少的病因、处理方法、分娩方式及新生儿情况。方法回顾性分析60例妊娠合并中重度血小板减少症患者的临床资料。结果妊娠合并中重度血小板减少的主要原因是特发性血小板减少症(ITP)25例(41.7%);其次为妊娠期血小板减少症(GT)20例(33.3%)。糖皮质激素治疗有效率为72.7%,地塞米松+丙种球蛋白全部治疗有效,血小板输注有效率达75%。3种方法治疗前后血小板计数差别有统计学意义(P0.01)。41例行剖宫产,19例阴道分娩。4例出现产后出血,均存在宫缩乏力,Spearman相关分析剖宫产病例的产后出血与治疗后的血小板计数之间存在负相关(r=-0.376,P=0.015)。新生儿4例出现血小板减少,其母亲均为ITP,2例有脾切除史的新生儿血小板均10×109 L-1,1例新生儿出现消化道出血及颅内出血。结论妊娠合并中重度血小板减少以ITP及GT为主。糖皮质激素、丙种球蛋白和血小板制剂是治疗的有效手段。治疗后血小板50×109 L-1或有产科指征行剖宫产,应有良好的宫缩来预防产后出血。治疗对剖宫产术中出血有一定的预防作用。ITP孕妇分娩的新生儿应监测血小板。对于有脾切除史的孕妇应充分告知发生严重新生儿血小板减少的风险及新生儿颅内出血的可能。
[Abstract]:Objective to investigate the etiology, treatment, delivery and neonatal status of moderate and severe thrombocytopenia in pregnancy. Methods the clinical data of 60 pregnant women with moderate and severe thrombocytopenia were analyzed retrospectively. Results the main causes of moderate and severe thrombocytopenia in pregnancy were idiopathic thrombocytopenia in 25 cases (41.7%), followed by gestational thrombocytopenia in 20 cases (33. 3%). The effective rate of glucocorticoid therapy was 72.7%, and dexamethasone gamma globulin was effective. The effective rate of platelet transfusion was 75.3. The difference of platelet count before and after treatment was statistically significant. There were 19 cases of vaginal delivery and 4 cases of postpartum hemorrhage in 19 cases of vaginal delivery. There was a negative correlation between postpartum hemorrhage and platelet count after treatment. There were 4 cases of thrombocytopenia in newborns, 2 cases of neonatal thrombocytopenia occurred in the mother of ITP and 2 cases had a history of splenectomy. One case of neonatal hemorrhage of digestive tract and intracranial hemorrhage occurred in 10 脳 109 L ~ (-1). Conclusion ITP and GT are the main causes of moderate and severe thrombocytopenia in pregnancy. Glucocorticoids, gamma globulin and platelet preparations are effective treatments. After treatment, 50 脳 109 L -1 platelets or obstetrically indicated caesarean section should have good uterine contraction to prevent postpartum hemorrhage. Treatment has some preventive effect on hemorrhage during cesarean section. Platelets should be monitored in neonates born with ITP. Pregnant women with a history of splenectomy should be fully informed of the risk of severe neonate thrombocytopenia and the possibility of neonatal intracranial hemorrhage.
【作者单位】：福建医科大学附属协和医院妇产科;
【分类号】：R714.254

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