Kenan KAYGUSUZ, Sinan GÜRSOY, Nur KUNT, İBRAHİM HALUK KAFALI

Yoğun bakımda HELLP sendromuna yaklaşım (yedi olgu sunumu)

HELLP sendromu hemoliz, serum aspartat aminotransferaz ve laktat dehidrogenaz seviyesinin yüksekliği ve düşük trombosit sayısı ile karakterizedir ve patogenezi tam olarak belli değildir. 2001-2003 yılları arasında yoğun bakım ünitesinde takip ettiğimiz 7 HELLP sendromlu hastayı sunuyoruz. Hastalar 18-28 yaş arasında ve 26-38 gebelik haftasında idiler. 3 hastada antepartum, 4 hastada postpartum dönemde HELLP sendromu gelişti. Eksitus olan 3 hastanın hastanemize geldiklerindeki Glasgow Koma Skoru (GKS) 3-4 idi. 6 hastanın mekanik ventilasyon gereksinimi oldu. Beyin tomografisinde 7 hastanın 3'ünde beyin ödemi belirlendi. Uç hastada ARDS ve 2 hastada akut böbrek yetmezliği tespit edildi. Dört hasta, solunum fonksiyonları ve laboratuvar değerleri normale döndükten sonra kadın doğum kliniğine gönderildiler. HELLP sendromlu hastalarda ciddi komplikasyonlar gelişebileceğinden bu hastaların klinik ve laboratuvar bulguları düzelene kadar yoğun bakım ünitelerinde takip edilmelerinin uygun olduğu kanısındayız.

Anahtar Kelimeler:

Yoğun bakım üniteleri, HELLP sendromu

Approach to HELLP syndrome in intensive care unit (seven case reports)

HELLP Syndrome is characterised by hemolysis, elevated serum levels of aspartate aminotransferase and lactate dehydrogenase and low platelet count. The pathogenesis of HELLP Syndrome remains unclear. We presented the follow up of 7 HELLP syndrome cases in the intensive care unit between 2001-2003. Patients were between 18-28 years of age and gestational ages were between 26-38 weeks. HELLP syndrome occured in the antepartum period in 3 patients and in the postpartum period in the 4 patients. Three patients with Glasgow Coma Score between 3-4 died. Six cases required mechanical ventilation therapy. CT revealed brain edema in 3 patients. ARDS was diagnosed in 3 patients and acute renal failure developed in 2 patients. When respiratory functions and laboratory values returned to normal, 4 patients were transferred to obstetrics and gynecology ward. Because severe complications may develop in HELLP syndrome, we think that the patients must be observed in ICU until the clinical and laboratory findings recover.

Keywords:

Intensive Care Units, HELLP Syndrome,

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