59例HELLP综合征肾损害的临床分析

发布时间：2018-05-17 00:23

本文选题：HELLP综合征 + 肾损害　；参考：《苏州大学》2014年硕士论文

【摘要】：目的总结HELLP综合征肾损害的临床特征，治疗和预后，提高临床对HELLP综合征肾损害的认识。方法回顾性分析苏州市立医院本部及苏大附一院2010年1月至2013年12月以来住院治疗的59例HELLP综合征患者肾损害的临床特点，实验室检查结果，治疗及预后情况。结果患者年龄16～47岁，平均（29.89±5.92）岁。其中初产妇27例（45.8%，16～41岁，平均31.75±5.85岁），经产妇32例（54.2%，21～47岁，平均27.71±5.29岁），产次为1～2次。产前发病49例，产后发病10例，产前发病患者确诊时孕周24+1周～39+3周，产后发病者均在产后48小时内。HELLP综合征肾损害常见的临床表现为高血压（100%），双下肢水肿（81.4%），头晕头痛（37.3%），肉眼血尿（13.6%），少尿（10.2%），蛋白尿（100%），血肌酐升高（64.4%）。 HELLP综合征肾损害的治疗主要包括解痉降压、激素以及血浆治疗和肾脏替代治疗等。本研究中降压药物使用有硫酸镁（88.1%），硝苯地平（72.9%），氨氯地平（18.6%），非洛地平（10.2%），尼卡地平（8.5%），拉贝洛尔（84.8%），，倍他乐克（6.8%），硝酸甘油（8.5%），硝普钠（1.7%），厄贝沙坦（6.8%），缬沙坦（1.7%），其中55例（93.2%）患者血压达标。所有患者均使用激素治疗，主要为地塞米松和甲强龙。地塞米松剂量为产前10～20mg静脉注射，每日1次，直至分娩；产后使用1～5天。甲强龙使用剂量为40mg静脉注射，每日1次至分娩，产后每日1～2次，使用1～5天，减量为半量，使用1～3天。产后发病患者地塞米松10～30mg静脉注射，使用1～3天。甲强龙用量为40mg静脉注射，每日1～2次，使用1～5天，减量为半量，使用1～3天。2例患者改为甲泼尼龙口服，后逐渐减量。56例（94.9%）患者使用血浆治疗，其中2例严重患者行血浆置换治疗。38例血肌酐升高患者中，6例患者行CVVH或HD治疗。30.5%尿蛋白转阴，73%肾功能恢复，仅2例（5.3%）转变为CRF。结论1. HELLP综合征是一种严重妊娠期并发症，大多数产前发病，产后发病多见于产后48小时内。 2.HELLP综合征肾损害的主要临床表现为蛋白尿，高血压，双下肢水肿，头晕头痛，肉眼血尿，少尿和肾功能下降。 3. HELLP综合征肾损害患者早期诊断，及时使用激素及血浆治疗可能加快病情缓解，改善肾脏的长期预后。
[Abstract]:Objective to summarize the clinical features, treatment and prognosis of renal damage in HELLP syndrome and to improve the clinical understanding of renal damage in HELLP syndrome. Methods the clinical features, laboratory findings, treatment and prognosis of 59 patients with HELLP syndrome who were hospitalized from January 2010 to December 2013 in Suzhou Municipal Hospital and Suda Fu first Hospital were retrospectively analyzed. Results the age of the patients was 16 ~ 47 years, with an average age of 29.89 卤5.92 years. Among them, 27 cases (45.8) were 41 years old (mean 31.75 卤5.85 years old), 32 cases were 54.2 ~ 2147 years old (mean 27.71 卤5.29 years old). There were 49 cases of prenatal disease and 10 cases of postpartum onset. The gestational weeks were 24 1 weeks and 39 3 weeks when the patients were diagnosed. The common clinical manifestations of renal damage in patients with HELLP syndrome within 48 hours after delivery were hypertension, edema of both lower limbs (81.4), dizziness and headache (37.3%), gross hematuria (13.6m), oliguria (10.2%), proteinuria (100%), and elevated creatinine (64.4m). The treatment of renal damage in HELLP syndrome includes antispasmodic therapy, hormone therapy, plasma therapy and renal replacement therapy. The antihypertensive drugs used in this study included magnesium sulfate 88.1m, nifedipine 72.9, amlodipine 18.6m, felodipine 10.2g, nicardipine 8.5m, Labe Lorodine 84.8m, betaloc 6.8m, nitroglycerin 8.5m, nitroprusside 1.7m, irbesartan 6.8m, valsartan 1.7m, including 93.22um). All patients were treated with hormone, mainly dexamethasone and methylenolone. The dose of dexamethasone was intravenously injected with antepartum 10~20mg once a day until delivery. The dose of methylenolone was intravenously injected with 40mg, once a day until delivery, once a day after delivery, once a day, for 15 days, the dosage was reduced to half a dose, and the dosage was used for 1 to 3 days. Postpartum patients with dexamethasone 10~30mg were injected intravenously for 1 to 3 days. The dosage of methylenolone was intravenously injected with 40mg once a day, for 1 5 days, with a reduction of half a dose. For 1 day, 2 patients were treated with methylprednisolone orally, and then gradually decreased by .56 patients (94. 9%) patients were treated with plasma. Of the 38 patients with elevated serum creatinine, 6 patients were treated with CVVH or HD. 30.5% urine protein turned negative to 73% renal function and only 2 patients (5.3%) changed to CRF. Conclusion 1. HELLP syndrome is a severe complication of pregnancy. The main clinical manifestations of renal damage in 2.HELLP syndrome were proteinuria, hypertension, edema of both lower extremities, dizziness and headache, gross hematuria, oliguria and renal function decline. 3. Early diagnosis of renal damage in HELLP syndrome, timely use of hormone and plasma therapy may accelerate the remission of the disease and improve the long-term prognosis of the kidney.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692

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