产后HELLP综合征合并急性肾功能衰竭的循证预后

摘要

目的：为产后HELLP综合征合并急性肾功能衰竭患者提供临床预后。方法：提出临床问题后，检索并评价文献。结果：共纳入4个研究，虽然研究的质量较低，但是纳入的研究结果适合对本病例进行预后评价。产后HELLP综合征合并急性肾功能衰竭的患者可能死于多器官功能衰竭；初产妇、双胎妊娠生产后临床症状不明显，病程进展快、血压升高以及急性上腹痛均可能是预后不良的危险因素。早期评估母儿情况并诊断、积极治疗，应警惕产妇出现DIC和多器官功能衰竭，必要时给予血浆置换治疗，可能改善预后。结论：产后HELLP综合征发病较急，预后不佳，特别是临床表现不典型者。%Objective:To provide clinical evidence-based prognosis for patients with postpartum HEELP syndrome complicated with acute renal failure. Methods:The clinical question was proposed. Some database was searched to assess the evidence. Results:A total of 4 studies were included,however,the quality of the studies was low. The results of the studies was suitable for our patients. The death of patients with postpartum HEELP syndrome complicated with acute renal failure was attributed to multiple organ failure. The risk factors for poor prognosis was primipara, delivery after twin pregnancy, absence of typical symptoms, rapid clinical progression, high blood pressure, epigastric pain. Early assessment and diagnosis for maternal and infant, positive in intervention and be caution for the DIC and multiple organ failure, using plasmapheresis can improve the prognosis. Conclusion:Patients with postpartum HEELP syndrome complicated with acute renal failure have an acute process and poor prognosis, especially for patients without typical symptoms.