【摘要】：目的:探討妊娠期急性脂肪肝(acute fatty liver of pregnancy,AFLP)的臨床特征及其對(duì)母嬰預(yù)后產(chǎn)生的影響,為臨床上妊娠期急性脂肪肝患者的診斷以及治療提供參考依據(jù),提高妊娠期急性脂肪肝的救治水平。方法:回顧性分析選取成都醫(yī)學(xué)院第一附屬醫(yī)院、四川省人民醫(yī)院、錦江區(qū)婦幼保健院及西南醫(yī)科大學(xué)附屬醫(yī)院在2002年1月至2015年12月收治的36例妊娠急性脂肪肝患者作為研究對(duì)象,孕婦平均年齡為28.21±8.03歲(18~40歲),發(fā)病時(shí)孕周平均為35.99±2.31周(29~39周),其中32例初產(chǎn)婦(88.89%),4例(11.11%)經(jīng)產(chǎn)婦,并按凝血酶原活動(dòng)度(PTA)分為三組:PTA正常組(A組):75%≤PTA≤100%;輕度降低組(B組),40%≤PTA75%;極度降低組(C組):PTA40%。分別觀察終止妊娠前的實(shí)驗(yàn)室檢查指標(biāo)(血常規(guī)指標(biāo)、血脂指標(biāo)、肝酶指標(biāo)、凝血功能指標(biāo)等);分娩方式(陰道分娩、剖宮產(chǎn));并發(fā)癥和死亡情況;新生兒窒息率和圍生兒死亡率。結(jié)果:1.AFLP患者發(fā)病孕周為(35.99±2.31)周,多為初產(chǎn)婦(88.89%),男胎多(66.67%),惡心和嘔吐是最常見(jiàn)癥狀(69.44%)。2.肝功能指標(biāo)顯著升高:血清丙氨酸轉(zhuǎn)氨酶(298.72±290.41 U/L)、天冬氨酸轉(zhuǎn)氨酶(258.14±223.56 U/L)、乳酸脫氫酶(367.98±234.52 U/L)和直接膽紅素(79.86±87.57μmol/L);凝血功能障礙:凝血酶原時(shí)間(17.85±9.63s)、纖維蛋白原水平(0.75±0.81 g/L)、D-二聚體(2.53±3.82 mg/L),和纖維蛋白降解產(chǎn)物(44.25±49.02 mg/L)水平異常;伴有不同程度的肌酐、尿酸、白細(xì)胞升高及血小板減少。3.AFLP孕產(chǎn)婦主要的并發(fā)癥有低蛋白血癥(55.6%)、凝血功能障礙(58.3%)、急性腎功能衰竭(44.4%)和彌漫性血管內(nèi)凝血(DIC)(33.3%),按PTA分組發(fā)現(xiàn)B組、C組兩組低蛋白血癥、凝血功能障礙、急性腎功能衰竭、DIC、MODS等并發(fā)癥的發(fā)生比例明顯高于A組,差異具有統(tǒng)計(jì)學(xué)意義(p0.05);C組發(fā)生低蛋白血癥、凝血功能障礙、急性腎功能衰竭、DIC的比例明顯高于B組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。4.AFLP孕婦共娩出新生兒42個(gè),雙胎6例,其中男嬰26個(gè),女?huà)?6個(gè),死亡6個(gè)(均為男嬰),大多為早產(chǎn)(61.1%),多數(shù)發(fā)生于34-37周(41.7%),30.6%的新生兒產(chǎn)后即被送往ICU,有10例發(fā)生宮內(nèi)胎兒窘迫,有6例新生兒在產(chǎn)后由于各種并發(fā)癥死亡,有8例新生兒出生體重較正常新生兒體重偏低,其余新生兒均體健。結(jié)論:對(duì)于高度懷疑妊娠期急性脂肪肝的患者,加強(qiáng)產(chǎn)前檢查,重視臨床癥狀,結(jié)合實(shí)驗(yàn)室檢查和影像學(xué)檢查,對(duì)AFLP盡早確診,尤其是對(duì)于PTA極度降低的患者,確診后應(yīng)及時(shí)終止妊娠、加強(qiáng)多學(xué)科的綜合治療,以減少對(duì)母嬰預(yù)后的影響,提高妊娠期急性脂肪肝的救治水平。
[Abstract]:Objective: to investigate the clinical features of (acute fatty liver of precancerous fatty liver in pregnancy and its influence on the prognosis of mother and infant, and to provide a reference for the diagnosis and treatment of acute fatty liver in pregnancy. To improve the treatment level of acute fatty liver in pregnancy. Methods: the first affiliated Hospital of Chengdu Medical College and Sichuan Provincial people's Hospital were retrospectively analyzed. From January 2002 to December 2015, 36 patients with acute fatty liver of pregnancy were treated in the affiliated Hospital of Southwest Medical University and Maternal and Child Health Hospital of Jinjiang District. The average age of pregnant women was 28.21 鹵8.03 years (1840 years), and the average gestational weeks at onset was 35.99 鹵2.31 weeks (2939 weeks), of which 32 primipara (88.89%) had 4 cases (11.11%). According to prothrombin activity, (PTA) was divided into three groups: normal group (group A): 75% 鈮，

本文編號(hào)：2185959