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162例妊娠合并血小板减少的临床分析


作者单位:广州医学院第三附属医院血液科, 广东 广州 510150

【摘要】  目的:探讨妊娠合并血小板减少的病因和处理方法。方法:回顾性分析我院1993 年1月 至 2007 年10月收治的162 例妊娠并血小板减少患者的临床资料。结果:特发性血小板减少性紫癜(itp组)18例,占11.1%,妊娠高血压综合征(pih组)24例,占14.8%,妊娠期血小板减少症(pat组)98例,占60.4%。妊娠期血小板平均值itp组、pih组与pat组分别为25.4±16.2, 42.5±18.7, 76.2±23.4、61.3±13.5(×109/l),各组间有显著差异(p<0.05)。产后血小板恢复正常平均所需时间itp组、pih组与pat组分别为23d、6d、4d。各组输注浓缩血小板治疗或糖皮质激素与丙种球蛋白联合治疗前及治疗后d4血小板均有显著差异(p<0.05);单纯用糖皮质激素治疗前及治疗后第四天血小板itp组、pih组无统计学差异(p>0.05),而pat组治疗前后血小板亦有显著差异(p<0.05)。结论:妊娠合并血小板减少应积极查找病因,根据不同的病情给予恰当的治疗。给予输血小板、糖皮质激素、丙种球蛋白(ivigg)等综合治疗效果好。

【关键词】  妊 娠; 血小板减少; 特发性血小板减少性紫癜; 妊娠期血小板减少症

  clinical analysis of 162 thrombocytopenia in pregnany

  chen xue-mei,  liang guo-hua,  zhang jian-yu,  et al

  no.3 affiliated hospital to guangzhou medical college, guangdong guangzhou 510150, china

    abstract: objective:to study the cause and management of thrombocytopenia during pregnancy.  method: the data of 162 cases  with   thrombocytopenia   during pregnancy were revievoed trom jan.1993 to oct,2007.result: thrombocytopenia  was mainly caused by idiopathic thrombocytopenic purpura (itp group) 18 cases and accounted for 11.1%, pregnancy induced hypertension (pih group) 24 cases and accounted for14.8%, pregnancy-associated thrombocytopenia (pat group) 98 cases ,and accounted for 60.4%.the average of platelet number in itp group is 25.4±16.2(×109/l),that of is 42.5±18.7(×109/l)in pih group, 61.3±13.5(×109/l) in pat group. the average of  time of platelet recover normal in postpartum is for 23 days in itp group ,6 days  in pih group,4 days in  pat group .the platelet number increased significantly compared between pre and post 4 days therapy by platelet transfusion and by glucocorticoid combined immunoglobulin in all group(p<0.05),but that of nonsignificantly between pre and post 4 days therapy by only glucocorticoid in itp group and pih group(p>0.05).conclusion: the causes of  thrombocytopenia during pregnancy should  be searched for  and  proper therapy should be given according to different of cause.platelet transfusion and glucocorticoid and immunoglobulin is effective for severe thrombocytopenia during pregnancy.

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