本文關(guān)鍵詞：腎移植受者術(shù)后妊娠及母嬰預(yù)后：?jiǎn)沃行牡幕仡櫺钥偨Y(jié)　出處：《浙江大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 腎移植 妊娠 免疫抑制劑 母嬰預(yù)后

【摘要】：目的：對(duì)浙江大學(xué)附屬第一醫(yī)院所有腎移植術(shù)后成功分娩的女性受者予以總結(jié),探討腎移植術(shù)后妊娠過(guò)程對(duì)母體、胎兒及移植物本身的影響。 方法：回顧性分析浙江大學(xué)附屬第一醫(yī)院腎臟病中心自1992年4月至今資料,共有12名女性腎移植受者在術(shù)后成功妊娠并分娩,并各自生育子女1名。在腎移植手術(shù)醫(yī)院及生育醫(yī)院收集受者及其子女的資料,包括供腎類(lèi)型,受體手術(shù)時(shí)年齡、移植妊娠間期、妊娠期間免疫抑制劑的應(yīng)用、孕周、妊娠期間母體并發(fā)癥、分娩及麻醉方式、胎兒出生情況以及移植物預(yù)后等。 結(jié)果：12例受體里有10例(83.3%)接受了尸腎移植,有2例(16.7%)接受了活體腎移植,移植手術(shù)時(shí)的年齡為(22.8±4.3)歲,移植妊娠間期為(5.5±2.9)年,妊娠期間有5例(41.7%)使用了強(qiáng)的松、硫唑嘌呤和環(huán)孢素A抗排異,有6例(50.0%)使用了強(qiáng)的松、硫唑嘌呤和他克莫司聯(lián)用抗排異,有1例僅使用強(qiáng)的松和硫唑嘌呤抗排斥。所有的胎兒均通過(guò)連續(xù)硬膜外麻醉下剖宮產(chǎn)分娩,有1例因妊娠期間移植腎失功于28周進(jìn)行剖腹產(chǎn),有6例(50%)為早產(chǎn),5例足月產(chǎn)。12名子女男女比例為6：6,出生時(shí)體重為(2734±364)g,身高(48.1±3.1)cm,雙頂徑大小為(8.9±0.5)cm, Apgar評(píng)分為(9.9±0.2),出生時(shí)未發(fā)現(xiàn)明顯畸形,均進(jìn)行人工喂養(yǎng),目前年齡最大者為18歲,最小為3天。12例受者在妊娠期間并發(fā)子癇前期(包括高血壓)6例次,蛋白尿5例次,貧血4例次,移植腎功能不全3例次,妊娠期糖尿病2例次。 結(jié)論：腎移植受體在術(shù)后可以進(jìn)行妊娠,但有一定的風(fēng)險(xiǎn),可能會(huì)影響移植物的功能。整個(gè)妊娠過(guò)程均需移植科醫(yī)師與產(chǎn)科醫(yī)師的密切配合隨訪,通過(guò)選擇最佳懷孕時(shí)機(jī)、嚴(yán)密監(jiān)測(cè)孕期各項(xiàng)化驗(yàn)指標(biāo),最終能提高腎移植術(shù)后受體妊娠的成功率,為育齡期尿毒癥女患者帶來(lái)家庭的福音。
[Abstract]:Objective: to summarize all the female recipients of successful delivery after renal transplantation in the first affiliated Hospital of Zhejiang University, and to explore the effect of pregnancy process on maternal, fetal and graft itself. Methods: the data of renal disease center of the first affiliated Hospital of Zhejiang University since April 1992 were retrospectively analyzed. There were 12 female renal transplant recipients who were pregnant and delivered successfully after operation. The data of recipients and their children were collected in the renal transplantation hospital and fertility hospital, including the type of donor kidney, the age of recipient at the time of operation, the period of transplantation pregnancy, the application of immunosuppressant during pregnancy. Gestational weeks, maternal complications during pregnancy, delivery and anaesthesia, fetal birth and graft prognosis. Results of the 12 recipients, 10 received cadaveric kidney transplantation and 2 received live kidney transplantation. The age of transplantation was 22. 8 鹵4. 3 years. During pregnancy, prednisone, azathioprine and cyclosporine A were used in 5 (5.5 鹵2.9) years, and prednisone, azathioprine and cyclosporine A were used in 6 (50.0) years. Azathioprine and tacrolimus were used in combination with anti-rejection. In one case only prednisone and azathioprine were used against rejection. All fetuses were delivered by cesarean section under continuous epidural anesthesia. One case underwent caesarean section at 28 weeks due to kidney transplantation during pregnancy, and 6 cases underwent cesarean section. The ratio of male to female was 6: 6 in 5 cases of term labor and 5 cases of term delivery. The birth weight was 2734 鹵364g, the height was 48.1 鹵3.1 cm, the biparietal diameter was 8.9 鹵0.5 cm, and the Apgar score was 9.9 鹵0.2). No obvious malformation was found at birth. The oldest was 18 years old and the youngest was 3 days. 12 recipients were complicated with preeclampsia during pregnancy (including 6 cases of hypertension). Proteinuria 5 times, anemia 4 times, renal allograft insufficiency 3 times, gestational diabetes 2 times. Conclusion: renal transplant recipients can be pregnant after operation, but there are certain risks, which may affect the function of grafts. The whole process of pregnancy should be closely followed up by transplant doctors and obstetricians. By selecting the best time of pregnancy and closely monitoring the laboratory indexes during pregnancy, the success rate of recipient pregnancy after renal transplantation can be improved, and the family gospel will be brought to the female patients with uremia at childbearing age.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R699.2

【共引文獻(xiàn)】

相關(guān)期刊論文 前5條

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相關(guān)博士學(xué)位論文 前1條

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本文編號(hào)：1421838