CAJ | 학술논문

目的：探讨产后溶血性尿毒症综合征(PHUS)的临床特征,为该病的早期诊断、及时治疗和改善预后提供依据。方法选择2008年1月至2012年12月南京医科大学附属苏州医院收治的6例PHUS患者的病历资料为研究对象,孕龄≥33孕周。采用回顾性分析法分析其临床症状、体征、溶血性尿毒症相关指标、超声检查及外周血涂片等检查结果(本研究遵循的程序符合南京医科大学附属苏州医院人体试验委员会制定的伦理学标准,得到该委员会批准)。结果本研究6例患者均为妊娠合并重度先兆子痫,经解痉、降压治疗并促胎肺成熟后,行剖宫产术分娩,并获活产新生儿者。6例患者均于剖宫产术后1~2d无诱因出现进行性少尿及无尿,合并溶血性贫血、血小板减少和肾功能急剧下降等,经过连续肾脏替代治疗(CRRT)联合血浆置换为主的综合治疗后病情稳定,好转出院。对其随访1年,其中3例(50.0%)患者失访,1例(16.7%)患者发展为慢性肾功能不全。结论先兆子痫是PHUS的重要诱因之一,应加强先兆子痫孕妇产后的肾功能监测,早期诊断PHUS,及时进行专科治疗,这对降低产妇死亡率和保障母亲健康具有重要意义。
목적：탐토산후용혈성뇨독증종합정(PHUS)적림상특정,위해병적조기진단、급시치료화개선예후제공의거。방법선택2008년1월지2012년12월남경의과대학부속소주의원수치적6례PHUS환자적병력자료위연구대상,잉령≥33잉주。채용회고성분석법분석기림상증상、체정、용혈성뇨독증상관지표、초성검사급외주혈도편등검사결과(본연구준순적정서부합남경의과대학부속소주의원인체시험위원회제정적윤리학표준,득도해위원회비준)。결과본연구6례환자균위임신합병중도선조자간,경해경、강압치료병촉태폐성숙후,행부궁산술분면,병획활산신생인자。6례환자균우부궁산술후1~2d무유인출현진행성소뇨급무뇨,합병용혈성빈혈、혈소판감소화신공능급극하강등,경과련속신장체대치료(CRRT)연합혈장치환위주적종합치료후병정은정,호전출원。대기수방1년,기중3례(50.0%)환자실방,1례(16.7%)환자발전위만성신공능불전。결론선조자간시PHUS적중요유인지일,응가강선조자간잉부산후적신공능감측,조기진단PHUS,급시진행전과치료,저대강저산부사망솔화보장모친건강구유중요의의。
Objective To investigate the clinic features of postpartum hemolytic uremic syndrome (PHUS)for early diagnosis,prompt therapy and better prognosis.Methods A retrospective study was conducted on clinical data of 6 PHUS patients with gestational age over 33 weeks in Suzhou Hospital Affiliated to Nanjing Medical University from January 2008 to December 2012.Clinical symptoms and signs,hemolytic uremic related indexes,ultrasonograph and peripheral blood smear of them were analyzed. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Suzhou Hospital Affiliated to Nanjing Medical University.Results All 6 patients had pregnancy combined with severe preeclampsia.After antispasmodic,antihypertensive treatment and promot fetal lung mature,they gave birth by cesarean section,and no neonatal death.The main symptoms were gradually oliguria and anuria without remote cause,hemolytic anemia,thrombocytopenia and sharp decline of renal function after 1-2 days of cesarean section.Through comprehensive treatment based on continuous renal replacement therapy (CRRT)and plasma exchange,the patient′s conditions were stable and improved,and all patients were discharged from hospital.After 1 year follow up ,3 cases(50.0%)were lost to follow up,1 case(16.7%) with chronic renal insufficiency.Conclusions Preeclampsia is one of the important remote causes of PHUS.It′s necessary to strengthen renal function monitoring of pregnant women with preeclampsia after childbirth,in order to make early diagnosis and give specialized treatment in time,which are significant measures to reduce maternal mortality and ensure mother′s healthy.