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妊娠中晚期合并重症急性呼吸综合征的临床分析

[Clinical analysis of pregnancy in second and third trimesters complicated severe acute respiratory syndrome].

作者信息

Zhang Jian-ping, Wang Yun-hui, Chen Lei-ning, Zhang Rui, Xie Yu-fen

机构信息

Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Guangzhou 510120, China.

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2003 Aug;38(8):516-20.

Abstract

OBJECTIVE

To explore and analyze the clinical manifestation, diagnosis, management and maternal-perinatal prognosis of severe acute respiratory syndrome (SARS)-complicated pregnancy in second and third trimesters.

METHODS

Clinical data of 5 inpatients with SARS-complicated pregnancy in second and third trimesters from 4(th) February to 17(th) March 2003 were analyzed retrospectively.

RESULTS

Five patients were all primigravida (including 2 twins). Two were infected in second trimester while the other 3 in third trimester with 2 hospital-acquired infections and 3 community-acquired infections. All patients had fever (5/5), 3 chills or rigor, 4 cough; 2 with decreased lymphocyte, 2 decreased platelet, 3 elevated alanine aminotransferase (ALT), 4 hypoalbuminemia, 5 abnormal chest radiographs. All 5 patients were cured with 1 requiring intensive care. 5 neonates including 1 twins have been followed up without evidence of SARS infections up to now. In a twin-pregnancy 1 fetus was lost while the pregnant's situation is stable.

CONCLUSIONS

Common diagnostic criteria were Suitable for SARS-complicated pregnancy in second and third trimesters, but attention should be paid to the interaction between SARS and special pathological changes during pregnancy. Patients should be isolated and monitored intensively with timely cesarean section in severe cases, which could significantly decrease the maternal-perinatal mortality. The use of corticosteroids and psychological supports need further study.

摘要

目的

探讨和分析妊娠中晚期合并严重急性呼吸综合征(SARS)的临床表现、诊断、处理及母婴预后。

方法

回顾性分析2003年2月4日至3月17日收治的5例妊娠中晚期合并SARS患者的临床资料。

结果

5例患者均为初产妇(其中2例为双胎妊娠)。2例在妊娠中期感染,3例在妊娠晚期感染,其中2例为医院获得性感染,3例为社区获得性感染。所有患者均有发热(5/5),3例有寒战或畏寒,4例咳嗽;2例淋巴细胞减少,2例血小板减少,3例丙氨酸转氨酶(ALT)升高,4例低蛋白血症,5例胸部X线片异常。5例患者均治愈,其中1例需重症监护。5例新生儿(包括1例双胎中的1个胎儿)至今随访无SARS感染证据。1例双胎妊娠中1个胎儿丢失,孕妇情况稳定。

结论

通用诊断标准适用于妊娠中晚期合并SARS,但应注意SARS与孕期特殊病理变化之间的相互影响。患者应隔离并密切监测,重症时及时剖宫产,可显著降低母婴死亡率。糖皮质激素的使用及心理支持有待进一步研究。

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