OUR EXPERIENCE ABOUT HELLP SYNDROME IN INTENSIVE CARE UNIT

Öz

Aim: HELLP syndrome is a life-threatening condition frequently associated with severe preeclampsia-eclampsia and is characterized by hemolysis, elevated liver enzymes and low plateletes. The aim of our study was to evaluate retrospectively the patients with HELLP syndrome admitted to the intensive care unit (ICU). Material and Methods: We retrospectively reviewed the medical records of 19 patients with HELLP syndrome admitted to ICU between January 2011 and December 2015. Results: The mean maternal age was 30.0 ± 5.1 years and the mean gestational age was 32.2 ± 4.8 weeks of 19 patients with HELLP syndrome admitted to the ICU. The mean Acute Physiology and Chronic Health Evaluation System (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, Glasgow Coma Scale (GCS) were 25.9 ± 4.0, 14.2 ± 2.8 and 5.2 ± 2.7 at ICU admission, respectively. Mechanical ventilation was required for 12 patients (63.6%). Eight patients (42.1%) had acute kidney injury and only 1 patient was required renal replacement therapy. Therapeutic plasma exchange was performed to 11 patients (57.9%). Three patients (15.8%) had dissemine intravascular coagulation (DIC), 5 patients (26.3%) acute respiratory distress syndrome (ARDS), 3 patients (15.8%) septic shock, and 1 patient (5.3%) cardiogenic shock. The mean length of ICU stay was 8.1 ± 4.7 days. Both of maternal and fetal mortality rate was 10.5%. Conclusion: Maternal/fetal morbidity and mortality are high in HELLP syndrome. Early diagnosis, close follow-up in intensive care unit, appropriate treatment and management by multidisciplinary team may prevent complications and improve prognosis of HELLP syndrome.

Anahtar Kelimeler

• HELLP syndrome
• preeclampsia
• eclampsia
• pregnancy
• intensive care unit

YOĞUN BAKIM ÜNİTEMİZDE HELLP SENDROMU DENEYİMLERİMİZ

Öz

Amaç: HELLP sendromu, hemoliz, yükselmiş karaciğer enzimleri ve trombosit sayısında azalma ile karakterize, ağır pre¬eklampsi ve eklampsiyle ilişkili hayatı tehdit eden bir durumdur. Çalışmamızın amacı, yoğun bakım ünitesine (YBÜ) kabul edilen HELLP sendromlu hastaları retrospektif olarak değerlendirmektir. Gereç ve Yöntemler: Ocak 2011 ile Aralık 2015 arasında yoğun bakım ünitesine kabul edilen 19 HELLP sendromlu hastanın medikal kayıtlarını retrospektif inceledik. Bulgular: Yoğun bakım ünitesine kabul edilen 19 HELLP sendromlu hastanın ortalama yaşı 30.0 ± 5.1 yıl ve ortalama gebelik yaşı 32.2 ± 4.8 hafta idi. YBÜ kabuldeki ortalama Akut Fizyoloji ve Kronik Sağlık Değerlendirme Sistemi (APACHE II) skoru, Sıralı Organ Yetmezliği Değerlendirmesi (SOFA) skoru, Glasgow Koma Skalası (GCS) sırasıyla 25.9 ± 4.0, 14.2 ± 2.8 ve 5.2 ± 2.7 idi. On iki hastanın (%63,6) mekanik ventilasyon gereksinimi oldu. Sekiz hastanın (%42.1) akut böbrek hasarı varken sadece 1 hastaya renal replasman tedavisi gerekti. On bir hastaya (%57.9) terapötik plazma değişimi yapıldı. Üç hastada (%15.8) yaygın damar içi pıhtılaşma (DIC), 5 hastada (%26.3) akut solunum sıkıntısı sendromu (ARDS), 3 hastada (%15.8) septik şok ve 1 hastada (%5.3) kardiyojenik şok vardı. Ortalama YBÜ kalış süresi 8.1 ± 4.7 gündü. Hem anne hem de fetal mortalite oranı %10,5 idi. Sonuç: HELLP sendromunda, maternal/fetal morbidite ve mortalite riski yüksektir. Erken tanı, yoğun bakım ünitesinde yakın takip, multidisipliner ekip tarafından yönetim HELLP sendromunun komplikasyonlarını önleyebilir ve prognozu iyileştirebilir.

Anahtar Kelimeler

• HELLP sendromu
• preeklampsi
• eklampsi
• gebelik
• yoğun bakım ünitesi
• HELLP syndrome
• preeclampsia
• eclampsia
• pregnancy
• intensive care unit

Kaynakça

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