Magann E F, Perry K G, Meydrech E F, Harris R L, Chauhan S P, Martin J N
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505.
Am J Obstet Gynecol. 1994 Oct;171(4):1154-8. doi: 10.1016/0002-9378(94)90055-8.
Because most morbidity and mortality associated with atypical preeclampsia and the syndrome of hemolysis, elevated liver enzymes, and low platelets is a postpartum phenomenon, we undertook this investigation to evaluate the use of high-dose corticosteroids to minimize maternal morbidity and accelerate postpartum recovery in patients with this form of severe preeclampsia.
Into this prospective, randomized study 40 parturients with the syndrome were recruited. The syndrome was defined by a clinical presentation consistent with a diagnosis of severe preeclampsia or eclampsia in addition to laboratory evidence of hemolysis, hepatic dysfunction, and thrombocytopenia. Immediately post partum 20 parturients assigned to the treatment group received four doses of intravenous dexamethasone at 12-hour intervals (10 mg, 10 mg, 5 mg, 5 mg) over 36 hours. Patients assigned to the control group received no corticosteroids. All study subjects were intensively monitored by mean arterial pressure and urinary output every 2 hours, hematocrit and platelet count every 6 hours and lactic dehydrogenase, aspartate aminotransferase, and alanine aminotransferase every 12 hours for the first 48 hours post partum.
The steroid-treated group with the syndrome of hemolysis, elevated liver enzymes, and low platelets had significant changes over time in mean arterial pressure, urinary output, platelet count, lactic dehydrogenase and aspartate aminotransferase versus the control group with the syndrome. Relative to the control group, the mean arterial pressure became significantly decreased at 22 hours in the steroid-treated group (p < 0.03), urinary output increased significantly by 16 hours (p < 0.02), the platelet count increased significantly by 24 hours (p < 0.05), and both lactic dehydrogenase and aspartate aminotransferase decreased significantly by 36 hours (p < 0.04 and p < 0.05, respectively).
In association with high-dose corticosteroid administration, parturients with the syndrome of hemolysis, elevated liver enzymes, and low platelets recovered from the disease process more rapidly than did control subjects, as measured by urinary output, mean arterial pressure, platelet count, lactic dehydrogenase, and aspartate aminotransferase. In this disease process, which has significant associated morbidity and mortality, especially in patients with advanced cases, high-dose corticosteroid therapy appears to significantly hasten recovery and lessen the severity of the disease post partum. We postulate that use of this therapeutic approach in properly selected patients could result in lessened overall maternal morbidity and mortality, shorter patient stays in recovery and intensive-care areas, and shorter overall hospitalization with reduced medical care costs.
由于与非典型先兆子痫以及溶血、肝酶升高和血小板减少综合征相关的大多数发病和死亡情况是产后现象，我们开展了这项研究，以评估使用大剂量皮质类固醇来将这种严重先兆子痫患者的孕产妇发病率降至最低并加速产后恢复的效果。
在这项前瞻性随机研究中，招募了40例患有该综合征的产妇。该综合征的定义为临床表现符合重度先兆子痫或子痫的诊断，同时伴有溶血、肝功能障碍和血小板减少的实验室证据。产后即刻，分配至治疗组的20例产妇在36小时内每隔12小时接受4剂静脉注射地塞米松（10毫克、10毫克、5毫克、5毫克）。分配至对照组的患者未接受皮质类固醇治疗。在产后的头48小时内，所有研究对象每2小时通过平均动脉压和尿量进行严密监测，每6小时监测血细胞比容和血小板计数，每12小时监测乳酸脱氢酶、天冬氨酸转氨酶和丙氨酸转氨酶。
与患有溶血、肝酶升高和血小板减少综合征的对照组相比，接受类固醇治疗的该综合征组在平均动脉压、尿量、血小板计数、乳酸脱氢酶和天冬氨酸转氨酶方面随时间有显著变化。相对于对照组，接受类固醇治疗的组在22小时时平均动脉压显著降低（p < 0.03），在16小时时尿量显著增加（p < 0.02），在24小时时血小板计数显著增加（p < 0.05），乳酸脱氢酶和天冬氨酸转氨酶在36小时时均显著降低（分别为p < 0.04和p < 0.05）。
与给予大剂量皮质类固醇相关，患有溶血、肝酶升高和血小板减少综合征的产妇从疾病过程中恢复得比对照组更快，这通过尿量、平均动脉压、血小板计数、乳酸脱氢酶和天冬氨酸转氨酶来衡量。在这个具有显著相关发病率和死亡率的疾病过程中，尤其是在病情严重的患者中，大剂量皮质类固醇疗法似乎能显著加速恢复并减轻产后疾病的严重程度。我们推测，在适当选择的患者中使用这种治疗方法可能会降低孕产妇的总体发病率和死亡率，缩短患者在恢复区和重症监护区的停留时间，以及缩短总体住院时间并降低医疗费用。
