福建医科大学学报
福建醫科大學學報
복건의과대학학보
Journal of Fujian Medical University
2015年
3期
182-186
,共5页
妊娠%中重度血小板减少%分娩方式%产后出血
妊娠%中重度血小闆減少%分娩方式%產後齣血
임신%중중도혈소판감소%분면방식%산후출혈
pregnancy%moderate to severe thrombocytopenia%mode of delivery%postpartum hemorrhage
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（P＜0．01）。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IT P ，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。IT P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。
目的：探討妊娠閤併中重度血小闆減少的病因、處理方法、分娩方式及新生兒情況。方法迴顧性分析60例妊娠閤併中重度血小闆減少癥患者的臨床資料。結果妊娠閤併中重度血小闆減少的主要原因是特髮性血小闆減少癥（ITP）25例（41．7％）；其次為妊娠期血小闆減少癥（GT）20例（33．3％）。糖皮質激素治療有效率為72．7％，地塞米鬆＋丙種毬蛋白全部治療有效，血小闆輸註有效率達75％。3種方法治療前後血小闆計數差彆有統計學意義（P＜0．01）。41例行剖宮產，19例陰道分娩。4例齣現產後齣血，均存在宮縮乏力，Spearman相關分析剖宮產病例的產後齣血與治療後的血小闆計數之間存在負相關（ r＝－0．376，P＝0．015）。新生兒4例齣現血小闆減少，其母親均為IT P ，2例有脾切除史的新生兒血小闆均＜10×109 L －1，1例新生兒齣現消化道齣血及顱內齣血。結論妊娠閤併中重度血小闆減少以ITP及GT為主。糖皮質激素、丙種毬蛋白和血小闆製劑是治療的有效手段。治療後血小闆＜50×109 L －1或有產科指徵行剖宮產，應有良好的宮縮來預防產後齣血。治療對剖宮產術中齣血有一定的預防作用。IT P孕婦分娩的新生兒應鑑測血小闆。對于有脾切除史的孕婦應充分告知髮生嚴重新生兒血小闆減少的風險及新生兒顱內齣血的可能。
목적：탐토임신합병중중도혈소판감소적병인、처리방법、분면방식급신생인정황。방법회고성분석60례임신합병중중도혈소판감소증환자적림상자료。결과임신합병중중도혈소판감소적주요원인시특발성혈소판감소증（ITP）25례（41．7％）；기차위임신기혈소판감소증（GT）20례（33．3％）。당피질격소치료유효솔위72．7％，지새미송＋병충구단백전부치료유효，혈소판수주유효솔체75％。3충방법치료전후혈소판계수차별유통계학의의（P＜0．01）。41례행부궁산，19례음도분면。4례출현산후출혈，균존재궁축핍력，Spearman상관분석부궁산병례적산후출혈여치료후적혈소판계수지간존재부상관（ r＝－0．376，P＝0．015）。신생인4례출현혈소판감소，기모친균위IT P ，2례유비절제사적신생인혈소판균＜10×109 L －1，1례신생인출현소화도출혈급로내출혈。결론임신합병중중도혈소판감소이ITP급GT위주。당피질격소、병충구단백화혈소판제제시치료적유효수단。치료후혈소판＜50×109 L －1혹유산과지정행부궁산，응유량호적궁축래예방산후출혈。치료대부궁산술중출혈유일정적예방작용。IT P잉부분면적신생인응감측혈소판。대우유비절제사적잉부응충분고지발생엄중신생인혈소판감소적풍험급신생인로내출혈적가능。
Objective To explore the causes ,treatment ,mode of delivery and neonatal situation about pregnancy with moderate‐to‐severe thrombocytopenia . Methods 60 cases of pregnancy with mod‐erate‐to‐severe thrombocytopenia were retrospectively analyzed . Results The main cause of pregnancy with moderate‐to‐severe thrombocytopenia is idiopathic thrombocytopenia (ITP) 25 cases ,for 41 .7% ;fol‐lowed by gestational thrombocytopenia (GT)20 cases ,for 33 .3% . The effectiveness of dexamethasone , dexamethasone + immunoglobulin and platelet transfusion respectively is 72 .2% ,100% ,75% . There was significant diference of platelet count before and after different treatments (P<0 .01) . 41 cases ce‐sarean section ,19 cases vaginal delivery ,postpartum hemorrhage 4 cases ,there are all esist uterine atony . Analyze by Spearman correlation . There is a negative correlation between postpartum hemorrhage and the platelet count after treatment(r=0 .376 ,P=0 .376) . Neonatal thrombocytopenia in 4 cases ,mothers are the IT P , mother has a history of splenectomy in 2 cases and neonatal platelets are less than 10 × 109 L -1 ,neonatal gastrointestinal bleeding and intracranial hemorrhage in 1 case . Conclusion ITP and GT are the primary causes of pregnancy with moderate‐to‐severe thrombocytopenia . Dexamethasone , immunoglobulin and platelet transfusion are effective methods for treatment . Platelet after treatment is lower than 50 × 109 L -1 as well as obstetrical indications cesarean delivery ,should have good contractions to prevent postpartum hemorrhage ,treatments have certain prevention of hemorrhage in cesarean section . Newborn babies should be monitoring platelet of ITP pregnant childbirth ,for pregnant women with a history of splenectomy should be fully informed of severe neonatal thrombocytopenia and the possibility of neonatal intracranial hemorrhage .
