Van Dam P A, Renier M, Baekelandt M, Buytaert P, Uyttenbroeck F
Department of Obstetrics and Gynecology, Saint Augustinus Hospital Wilrijk, Belgium.
Obstet Gynecol. 1989 Jan;73(1):97-102.
To clarify the role of disseminated intravascular coagulation (DIC) in women with the hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, serial coagulation studies were performed prospectively in 18 patients. A semiquantitative DIC scoring system was used retrospectively to augment the diagnostic confidence of coagulopathy. At the time of admission to the hospital, three patients showed no evidence of DIC, eight had suspected DIC, and seven had manifest DIC. The intravascular coagulation process was progressive in all patients; upon delivery, eight patients proved to have suspected DIC and ten had manifest DIC. The laboratory criteria of DIC were found to agree with the degree of organ dysfunction. Patients with manifest DIC at delivery developed significantly more life-threatening maternal complications than did patients with suspected DIC (P less than .02). Conservative management was not possible in any patients who were admitted with overt DIC because of deterioration of maternal and fetal status. Application of a sensitive DIC scoring system may be valuable in managing patients with the HELLP syndrome and selecting patients who may be treated expectantly.
为明确弥散性血管内凝血（DIC）在溶血、肝酶升高及血小板减少（HELLP）综合征患者中的作用，对18例患者进行了前瞻性连续凝血研究。回顾性使用半定量DIC评分系统以增强对凝血病的诊断信心。入院时，3例患者无DIC证据，8例疑似DIC，7例确诊DIC。所有患者的血管内凝血过程均呈进行性；分娩时，8例患者被证实为疑似DIC，10例确诊DIC。发现DIC的实验室标准与器官功能障碍程度相符。分娩时确诊DIC的患者出现危及生命的母体并发症的情况明显多于疑似DIC的患者（P＜0.02）。因母体和胎儿状况恶化，任何入院时确诊DIC的患者均无法进行保守治疗。应用敏感的DIC评分系统可能有助于管理HELLP综合征患者并选择可进行期待治疗的患者。
