妊娠期血小板减少144例临床分析.pdfVIP

1442 重庆医学2008年7月第37卷第13期 · 论 著· 妊娠期血小板减少144例临床分析 李宇迪，王 琳，常 青 (第三军医大学西南医院妇产科，重庆 400038) 摘 要：目的 探讨妊娠期血小板减少的主要原因、孕期监护、分娩及产后的影响。方法 回顾分析2003~2007年本院144 例妊娠期血小板减少的临床资料，分析血小板减少的原因，分娩方式的选择，产后母婴并发症情况。结果 144例中，妊娠相关性 血小板减少症(pregnancy associated thrombocytopenia，PAT)是孕期血小板减少的主要原因，次之是妊娠合并特发性血小板减少 性紫癍(idiopathic thrombocytopenic purpura，ITP)。当血小板小于或等于2O×1O ／L时剖宫产采用全麻，产后出血、产后官腔积 血发生率高。8例给予糖皮质激素、免疫球蛋白治疗或输注血小板治疗，其中5例是妊娠合并ITP或再生障碍性贫血(再障)，这5 例中4例是血小板小于或等于2O×1O ／L，在中孕锄 因患者担心药物引起胎儿畸形要求引产。结论 妊娠期血小板减少以PAT 多见，其次为ITP合并妊娠，当血小板小于或等于5O×1O。／L以下有出血倾向，尤其是血小板降到2O×1O。／L以 即使无出血倾 向，应到血液科进行检查和治疗。分娩方式无剖宫产指征的可在严密监护下行阴道分娩，产时及产后给予缩宫素及止血治疗。不 主张预防性治疗新生儿血小板减少。 关键词：血小板减少；妊娠 中图分类号：R714．254 文献标识码：A 文章编号：1671—8348(2008)13-1442—03 Retrospective clinical analysis of 1 14 cases of thrombocytopenia in pregnancy LI Yu—di，WANG Lin，CHANG Qing (Department of Obstetrics and Gynecology，Southwest Hospital，Third Military Medical University，Chongqing 400038，China) Abstract：Objective To investigate the causes，pregnancy monitor and impact on labour and postpartum of thrombocytopenia in pregnancy．Methods A retrospective study of 1 14 cases of thrombocytopenia in pregnancy in Southwest Hospital during 2003— 2007 was concluded．To analyse its cause，labouring style and complications．Results The first reason of thrombocytopenia in preg～ nancy was pregnancy-associated thrombocytopenia(PAT)and the second reason was idiopathic thrombocytopenic purpura(ITP)． When PLT was less than 20×10 ／L，the patients was operated with general anesthesia．There was high incidence in postpartum hemorrage and uterine hematocele．There were 8 patients accepting glucocorticosteroid，immunoglobulin or infusion of platelet，in which 5 patients were ITP or aplastic anemia，