【摘要】：目的探討妊娠期免疫性血小板減少癥(immune thrombocytopenia,ITP)母體干預(yù)治療對(duì)母兒并發(fā)癥及妊娠結(jié)局的影響。方法選擇2009年1月到2016年1月北京大學(xué)人民醫(yī)院產(chǎn)科收治的血小板計(jì)數(shù)有兩次或以上30×10~9/L妊娠期ITP 119例,給予系統(tǒng)孕期保健,根據(jù)不同治療方法分為單獨(dú)糖皮質(zhì)激素組(33例)、丙種球蛋白組(8例)、激素聯(lián)合丙球組(26例)和支持治療組(52例)4組。比較各組相關(guān)母體并發(fā)癥、分娩結(jié)局、新生兒和隨訪情況。結(jié)果 119例患者中,糖皮質(zhì)激素治療開(kāi)始孕周20~35孕周,用藥時(shí)間1~15周。丙種球蛋白治療開(kāi)始孕周16~36周,周期1~5個(gè)療程。妊娠期高血壓疾病(HDP)13例(10.9%),妊娠期糖尿病(GDM)18例(15.1%),貧血39例(32.8%),早產(chǎn)24例(20.2%),胎膜早破8例(6.7%);產(chǎn)后出血33例(27.7%),產(chǎn)褥感染1例(0.8%),無(wú)重要臟器自發(fā)出血及孕產(chǎn)婦死亡。4組在HDP與早產(chǎn)的發(fā)生率比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。激素治療組與無(wú)激素治療組HDP、GDM和早產(chǎn)發(fā)生率比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05),但兩組36周早產(chǎn)率比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。終止妊娠孕周30~(+6)~40~(+5)周。剖宮產(chǎn)76例(63.9%)。圍生兒119例,活產(chǎn)兒116例,死胎3例:無(wú)死產(chǎn)及新生兒死亡。新生兒血小板減低16例(13.4%),頭顱血腫1例。結(jié)論妊娠期ITP患者經(jīng)合理干預(yù)可獲得滿意妊娠結(jié)局。激素治療可導(dǎo)致HDP、GDM等相關(guān)并發(fā)癥增加,應(yīng)注意適應(yīng)證及監(jiān)測(cè)母體血壓、血糖變化。
[Abstract]:Objective to investigate the effect of maternal intervention on maternal and fetal complications and pregnancy outcome in patients with immune thrombocytopenia during pregnancy (immune thrombocytopenia,ITP). Methods from January 2009 to January 2016, there were two or more platelet counts in the obstetrics department of Peking University people's Hospital, including 30 脳 10 ~ 9 渭 L ITP during pregnancy, and all patients were given systemic care during pregnancy. According to different treatment methods, they were divided into four groups: glucocorticoid alone group (33 cases), immunoglobulin group (8 cases), hormone combined with propranolol group (26 cases) and support treatment group (52 cases). Maternal complications, delivery outcomes, newborns and follow-up were compared in each group. Results in 119 patients, glucocorticoid treatment began at 20-35 weeks, and the treatment lasted for 1-15 weeks. Gamma globulin treatment began to gestation weeks 16 weeks 36 weeks, cycle 1 and 5 courses. There were 13 cases of hypertensive disorder complicating pregnancy (HDP) (10.9%), 18 cases of gestational diabetes mellitus (GDM) (15.1%), 39 cases of anemia (32.8%), 24 cases of premature delivery (20.2%), 8 cases of premature rupture of membranes (6.7%). There were 33 cases of postpartum hemorrhage (27.7%), 1 case of puerperal infection (0.8%), no spontaneous hemorrhage of important organs and maternal mortality. There was significant difference in the incidence of HDP and premature delivery among the 4 groups (P0.05). There was a significant difference in the incidence of HDP,GDM and preterm delivery between hormone treatment group and non-hormone treatment group (P0.05), but there was no significant difference between the two groups in 36-week premature birth rate (P0.05). 30 ~ (6) ~ 40 ~ (5) weeks after termination of pregnancy. 76 cases (63.9%) were cesarean section. There were 119 perinatal infants, 116 live births and 3 dead fetuses: no stillbirth and neonatal death. Thrombocytopenia was found in 16 cases (13.4%) and hematoma in 1 case. Conclusion satisfactory pregnancy outcome can be obtained by reasonable intervention in pregnant patients with ITP. Hormone therapy can lead to HDP,GDM and other related complications, should pay attention to indications and monitor maternal blood pressure, blood glucose changes.
【作者單位】： 北京大學(xué)人民醫(yī)院婦產(chǎn)科;
【分類號(hào)】：R714.254

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