Martin J N, Files J C, Blake P G, Perry K G, Morrison J C, Norman P H
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA.
Am J Obstet Gynecol. 1995 Apr;172(4 Pt 1):1107-25; discussion 1125-7. doi: 10.1016/0002-9378(95)91470-6.
Our purpose was to investigate the postpartum use of plasma exchange in patients considered to have atypical preeclampsia-eclampsia manifested as persistent HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome with or without evidence of other organ injury.
During a 10-year period, 18 patients with HELLP syndrome were treated post partum with single or multiple plasma exchange with fresh-frozen plasma. Each patient was entered into the clinical trial either because of persistent evidence of atypical preeclampsia-eclampsia as HELLP syndrome > 72 hours after delivery (group 1) or with evidence of worsening HELLP syndrome at any time post partum in association with single- or multiple-organ injury (group 2). All procedures were performed with the IBM 2997 Cell Separator (IBM, Cobe Laboratories, Inc., Lakewood, Colo.) system. Maternal and perinatal outcomes were the main outcomes studied.
In the absence of other disease conditions, the 9 patients in group 1 with persistent postpartum HELLP syndrome complicated only by severe clinical expressions of preeclampsia-eclampsia responded rapidly to one or two plasma exchange procedures with few complications and no maternal deaths. In contrast, in the 9 patients of group 2 with HELLP syndrome presentations complicated by other organ disease, the response to plasma exchange was variable and there were two deaths in this group.
The current series of patients details the successful postpartum application of plasma exchange therapy for unremitting HELLP syndrome but reveals that a uniformly positive response to this therapy will not always be observed when there is additional single or multiple organ injury.
我们的目的是研究血浆置换在产后被认为患有非典型先兆子痫 - 子痫的患者中的应用，这些患者表现为持续性HELLP（溶血、肝酶升高和血小板减少）综合征，伴有或不伴有其他器官损伤的证据。
在10年期间，18例HELLP综合征患者在产后接受了单次或多次新鲜冷冻血浆置换治疗。每位患者因分娩后超过72小时仍持续存在非典型先兆子痫 - 子痫的证据（第1组）或产后任何时候出现HELLP综合征恶化并伴有单器官或多器官损伤的证据（第2组）而进入临床试验。所有操作均使用IBM 2997细胞分离器（IBM，科贝实验室公司，科罗拉多州莱克伍德）系统进行。母婴结局是主要研究的结局。
在没有其他疾病的情况下，第1组的9例产后持续性HELLP综合征患者仅伴有先兆子痫 - 子痫的严重临床表现，对一两次血浆置换治疗反应迅速，并发症少，无孕产妇死亡。相比之下，第2组的9例HELLP综合征伴有其他器官疾病的患者对血浆置换的反应各不相同，该组有2例死亡。
本系列患者详细介绍了血浆置换疗法在产后成功应用于持续性HELLP综合征，但表明当存在额外的单器官或多器官损伤时，并不总是能观察到对该疗法的一致阳性反应。
