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Yoğun Bakım Ünitemizde Sık Rastlanan Obstetrik Sorun: Hellp Sendromu (15 Olgunun Analizi)

The Common Obstetric Problem in our Intensive Care Unit: Hellp Syndrome (Analysis of 15 Cases)

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  • Selçuk Tıp Dergisi

Publication Year:

  • 2011

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Abstract (2. Language): 
Hellp Syndrome (Hemolysis-Elevated Liver enzymes-Low Platelets)is characterized by hemolysis, elevated liver enzymes and low platelet count, and related with an increased with an increased foetal and maternal mortality. We aimed in this study to evaluate the morbidity and mortality of 15 Hellp syndrome patients who have been admitted to our intensive care unit, between 2005 and 2009 years retrospectively. Patients ICU admission indications, demographic, clinical and obstetric data was noted down; hemoglobin, serum albumin level, prothrombine time ve active partial thromboplastin time, fibrinogen level, thrombocyte number, total bilirubine ve creatinine levels, AST, ALT, lactate dehidroginase (LDH) levels were analysed. Intensive care unit(ICU)admission of Hellp sydrome patients were convulsion, loss of consciousness, airway control, invasive hemodinamic monitorisation, ARDS, intracerebral hemorrhage and respiration insufficiency During 4 day intensive care unit following of our patients, thrombocyte numbers began to increase from third day of admission. But this increament was statistically significant between admission day to ICU and fourth day. Again similarly AST, ALT, LDH, ürea ve creatinine levels began to decreased at third day and decreament was statistically significant as from fourth day(P<0.05). Total bilirubin levels of our patients showed significant decrease as from second day. Ten of the patients needed invasive mechanical ventilation, 3 patients supported noninvasively with total face mask. Plasmapheresis applied to 3 patients because of resistant thrombocytopenia and acute renal failure. Only intracerebral hemorrhage patient was died because of sepsis. As a result, Hellp syndrome is one of the most frequent obstetric problems in ICU and has an increased foetal and maternal mortality. Especially Hellp Syndrome patients with convulsions whose clinics thought to be worse after vaginal delivery or C/S admittance to 3. step ICU may reduce complication rate and decrease mortality and morbidity. Plasmapheresis application may decrease organ insufficiencies in severe and resistant cases and increase clinical achievement .
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Abstract (Original Language): 
HELLP sendromu (Hemolysis-Elevated Liver enzymes-Low Platelets)hemoliz, yükselmiş karaciğer enzimleri ve trombosit sayısında azalma ile karakterize, yüksek maternal ve perinatal morbidite ve mortalite ile ilişkili bir tablodur. Biz çalışmamızda 2005-2009 arasında, yoğun bakımımızda takip ettiğimiz, Hellp Sendromlu 15 preeklamptik ve eklamptik hastayı retrospektif olarak inceledik. Hastaların yoğun bakıma alınma nedenleri , demografik, klinik ve obstetrik özellikleri kaydedilmiş,hemoglobin, serum albümin seviyesi, protrombin ve parsiyel tromboplastin zamanı,fibrinojen düzeyi, trombosit sayısı, total bilirubin ve kreatinin değerleri, AST, ALT, laktat dehidrogenaz düzeyleri incelenmiştir. Hellp sendromlu hastaların yoğun bakıma alınma nedenleri ciddi konvülsiyon, şuur kaybı , hava yolu kontrolü, invazif hemodinamik monitorizasyon, ARDS, intraserebral hemoraji ve solunum yetersizliği idi. Hastalarımızın yoğun bakımdaki 4 günlük takibi esnasında trombosit sayısı 3. günden itibaren yükselmeye başladı. Ancak bu yükselme yoğun bakıma kabul günü ile karşılaştırıldığında 4. günde istatistiksel olarak anlamlı idi. Yine benzer olarak AST, ALT, LDH, üre ve kreatinin değerleri 3. günden itibaren düşmeye başlarken 4. günden itibaren düşüş anlamlıydı (P<0.05). Hastalarımızın total bilirubin değerleri ise 2.günden itibaren istatistiksel olarak anlamlı düşüş gösterdi. Hastalardan 10 tanesi invaziv mekanik ventilasyona ihtiyaç göstermiş, 3 hasta ise total yüz maskesi ile noninvaziv olarak solunum desteği almıştır. 3 hastamıza dirençli trombositopeni ve akut böbrek yetmezliği olması üzerine plazmaferez uygulanmıştır. Sadece intraserebral hemoraji geçiren vaka sepsis nedeniyle kaybedilmiştir. Sonuç olarak Hellp Sendromu yoğun bakım ünitelerinde en sık rastlanan obstetrik problemlerden olup, yüksek maternal-fetal morbidite ve mortaliteye sahiptir. Özellikle konvülsiyon geçirmiş Hellp Sendromlu hastalar vajinal doğumdan veya C/S’den sonra klinik sürecin ağırlaşabileceği düşünülerek 3. basamak bir yoğun bakımda takip edilmesi komplikasyon oranını azaltıp morbidite ve mortaliteyi düşürebilecektir. Ciddi ve inatçı vakalarda plazmaferez uygulaması organ yetersizliklerini azaltarak klinik başarıyı artırabilir.
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