本文選題：HELLP綜合征 + 腎損害　； 參考：《蘇州大學(xué)》2014年碩士論文

【摘要】：目的總結(jié)HELLP綜合征腎損害的臨床特征，治療和預(yù)后，提高臨床對(duì)HELLP綜合征腎損害的認(rèn)識(shí)。 方法回顧性分析蘇州市立醫(yī)院本部及蘇大附一院2010年1月至2013年12月以來(lái)住院治療的59例HELLP綜合征患者腎損害的臨床特點(diǎn)，實(shí)驗(yàn)室檢查結(jié)果，治療及預(yù)后情況。 結(jié)果患者年齡16～47歲，平均（29.89±5.92）歲。其中初產(chǎn)婦27例（45.8%，16～41歲，平均31.75±5.85歲），經(jīng)產(chǎn)婦32例（54.2%，21～47歲，平均27.71±5.29歲），產(chǎn)次為1～2次。產(chǎn)前發(fā)病49例，產(chǎn)后發(fā)病10例，產(chǎn)前發(fā)病患者確診時(shí)孕周24+1周～39+3周，產(chǎn)后發(fā)病者均在產(chǎn)后48小時(shí)內(nèi)。HELLP綜合征腎損害常見的臨床表現(xiàn)為高血壓（100%），雙下肢水腫（81.4%），頭暈頭痛（37.3%），肉眼血尿（13.6%），少尿（10.2%），蛋白尿（100%），血肌酐升高（64.4%）。 HELLP綜合征腎損害的治療主要包括解痙降壓、激素以及血漿治療和腎臟替代治療等。本研究中降壓藥物使用有硫酸鎂（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%），拉貝洛爾（84.8%），，倍他樂(lè)克（6.8%），硝酸甘油（8.5%），硝普鈉（1.7%），厄貝沙坦（6.8%），纈沙坦（1.7%），其中55例（93.2%）患者血壓達(dá)標(biāo)。所有患者均使用激素治療，主要為地塞米松和甲強(qiáng)龍。地塞米松劑量為產(chǎn)前10～20mg靜脈注射，每日1次，直至分娩；產(chǎn)后使用1～5天。甲強(qiáng)龍使用劑量為40mg靜脈注射，每日1次至分娩，產(chǎn)后每日1～2次，使用1～5天，減量為半量，使用1～3天。產(chǎn)后發(fā)病患者地塞米松10～30mg靜脈注射，使用1～3天。甲強(qiáng)龍用量為40mg靜脈注射，每日1～2次，使用1～5天，減量為半量，使用1～3天。2例患者改為甲潑尼龍口服，后逐漸減量。56例（94.9%）患者使用血漿治療，其中2例嚴(yán)重患者行血漿置換治療。38例血肌酐升高患者中，6例患者行CVVH或HD治療。30.5%尿蛋白轉(zhuǎn)陰，73%腎功能恢復(fù)，僅2例（5.3%）轉(zhuǎn)變?yōu)镃RF。 結(jié)論1. HELLP綜合征是一種嚴(yán)重妊娠期并發(fā)癥，大多數(shù)產(chǎn)前發(fā)病，產(chǎn)后發(fā)病多見于產(chǎn)后48小時(shí)內(nèi)。 2.HELLP綜合征腎損害的主要臨床表現(xiàn)為蛋白尿，高血壓，雙下肢水腫，頭暈頭痛，肉眼血尿，少尿和腎功能下降。 3. HELLP綜合征腎損害患者早期診斷，及時(shí)使用激素及血漿治療可能加快病情緩解，改善腎臟的長(zhǎng)期預(yù)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 鹵5.92 years. Among them, 27 cases (45.8) were 41 years old (mean 31.75 鹵5.85 years old), 32 cases were 54.2 ~ 2147 years old (mean 27.71 鹵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.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692

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相關(guān)期刊論文 前4條

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