妊娠期急性脂肪肝18例临床分析

摘要

Objective To investigate the clinical features,diagnosis and therapy of acute fatty liver during pregnancy (AFLP).Methods A retrospective study was conducted on clinical data of 18 cases of acute fatty liver during pregnancy in Suzhou Municipal Hospital from Jun.2011 to Jun.2015.Records were reviewed for symptoms,signs,laboratory findings,imaging studies and comprehensive treatment.Results All of the 18 patients received immediate termination of the pregnancy when diagnosed as acute fatty liver(all 18 patients had different degrees of gastrointestinal symptoms before the onset of the disease,including 8 cases of epigastric pain,5 cases of jaundice,3 cases of systemic fatigue symptoms,combined with lab and imaging inspection),17 patients (94.44％) received cesarean section,one case (5.56％) was by shortened vaginal delivery.All 18 patients were given therapeutic plasma exchange,and were improved and discharged.One patient was hospitalized due to fetal death,the other 17 patients received healthy living babies.Conclusion Early diagnosis and reasonable therapy of AFLP can block the progression of the disease and reduce the damage of functional organs,improve the maternal prognosis,lower the maternal death rate,increase the fetal survival rate,and reduce AFLP complications,therefore is of great significance for protecting the maternal and infant health,reducing perinatal death.%目的 探讨妊娠期急性脂肪肝(AFLP)患者的临床特征、诊断过程和治疗方案,为早期诊断和早期治疗提供临床经验.方法 回顾性分析2011年6月至2015年6月苏州市立医院妇产科收治的18例AFLP患者的临床资料,对其临床特点、实验室检查及影像学检查和综合治疗进行分析.结果 18例患者发病前均有不同程度的消化道症状,其中8例患者上腹部胀痛,5例出现黄疸,3例出现全身乏力症状,结合实验室及影像学检查明确诊断后均立即终止妊娠,其中17例(94.44％)系剖宫产终止妊娠,1例(5.56％)患者入院时已临产,可短期结束分娩,予以缩短产程经阴道分娩.18例患者予以血浆置换治疗,均好转出院.1例患者胎死宫内入院,17例患者均获健康活婴.结论 AFLP的早期诊断和合理治疗可及时阻断该疾病进展,减少功能器官的损伤,大大改善孕妇的预后,降低产妇死亡率,增加胎儿存活率,减少AFLP的并发症,对保障母婴健康,减少围生儿死亡具有重要意义.