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妊娠高血压并发HELLP综合征的护理

目的 总结妊娠高血压并发溶血、肝酶升高及血小板减少综合征（HELLP）的发病率、临床特征及护理。 方法 分析2007年1月-2009年4月12例患HELLP综合征孕产妇资料。 结果 HELLP综合征发生率占重度子痫前期和子痫的8.33%（12/144），占同期住院分娩的0.15%（12/7 793）。91.67%（11/12）发生在产前。12例中引起产前子痫2例，眼底血管改变8例，视网膜出血3例，胎儿窘迫4例，胎盘早剥2例，子宫卒中1例，DIC 1例，严重腹水1例，妊高征心脏病1例，早期心衰1例，急性肾衰2例，脑出血1例，腹壁下血肿1例。经积极有效的治疗及精心的护理，无一例孕产妇及围产儿死亡。 结论 充分认识HELLP综合征的特殊临床表现，重视动态监测血常规、血小板、外周血涂片，肝肾功能，严密监护生命体征，准确记录尿量和尿色是早期发现妊娠高血压并发HELLP综合征的重要环节，有助于早诊断早治疗，加强病情观察，采取有效的护理措施，尽快终止妊娠，是改善母婴预后降低母婴病死率的关键。

HELLP综合征双眼渗出性视网膜脱离光相干断层扫描动态观察一例

Risk factors and optical coherence tomography characteristics of exudative retinal detachment in patients with HELLP syndrome

ObjectiveTo observe and analyze the risk factors and optical coherence tomography (OCT) characteristics of exudative retinal detachment in patients with HELLP syndrome. MethodsA retrospective clinical study. From January 2015 to March 2021, 168 eyes of 84 patients with HELLP syndrome who were hospitalized in The Third Central Hospital of Tianjin were included in the study. The average age of the patients was 30.96±4.09 years old. The patient’s general clinical data which included age, gestational week of delivery, type of HELLP syndrome, onset time of HELLP syndrome, parity, number of pregnancy, systolic and diastolic blood pressure, total amount and duration of glucocorticoid, whether been admitted to intensive care unit; laboratory indicators, which included platelet count,serum albumin, serum uric acid, 24-hour urine protein quantification,aspartate aminotransferase, lactate dehydrogenase, total bilirubin (TBIL) were collected. Whose the general condition was not allowed, however patients had a complaint of vision loss or suspected retinal detachment under direct ophthalmoscope examination, B-mode ultrasound was used to assist in the diagnosis. According to the presence or absence of exudative retinal detachment, patients were divided into retinal detachment group (net detachment group) and non-retinal detachment group (non-retinal detachment group), respectively 31 (36.90%, 31/84), 53 (63.10%, 53/84) cases. Among the 31 cases in the network disconnection group, 34 eyes in 17 cases underwent OCT. Two independent sample t tests were used to compare the measurement data of normal distribution between groups, Wilcoxon rank sum test was used to compare skewed distributions; the χ2 test was used to compare count data. The variables with statistical differences in univariate analysis were selected as independent variables, and binary logistic regression analysis was performed. ResultsAmong 84 patients, HELLP syndrome was classified into partial type and complete type, 41 (48.81%, 41/84) and 43 (51.19%, 43/84) cases, respectively. Compared with the non-net-off group, the patients in the off-line group had shorter gestational weeks (t=2.51), higher diastolic blood pressure (t=−2.61), greater total glucocorticoid use (Z=−2.14), and longer use time of glucocorticoid (Z=−2.75), the difference were statistically significant (P＜0.05); TBIL (Z=−2.49), serum albumin (t=2.06) levels decreased, and 24-hour urine protein quantitative (Z=−4.35) levels increased, the difference were statistically significant (P＜0.05). Logistic regression analysis showed that the increase of 24-hour urine protein level increased the risk of exudative retinal detachment (P＜0.05) (odds ratio=1.20, 95% confidence interval 1.06-1.37). Among the 34 eyes that underwent OCT examination, 18 eyes showed that the retinal pigment epithelium (RPE) layer was not smooth, thickened, and seemed to have adhesion to the detached retina. After the reattachment of retinal detachment, the above-mentioned changes of RPE still existed, but reduced; the ellipsoid zone still has discontinuity, partial rupture, and even extensive loss in 16 eyes. ConclusionThe quantitative increase of 24-hour urine protein is a risk factor for the occurrence of exudative retinal detachment in HELLP syndrome; some patients with exudative retinal detachment are still missing the ellipsoid zone after reattachment.