妊娠期糖尿病酮症酸中毒的预测及预警

妊娠期糖尿病酮症酸中毒是一种少见但却潜在威胁母儿生命安全的疾病。多见于1型糖尿病合并妊娠的患者,也可见于2型糖尿病合并妊娠患者和妊娠期糖尿病患者。对妊娠期糖尿病酮症酸中毒进行早期的识别和诊断,对改善母儿结局意义重大。文章就妊娠期糖尿病酮症酸中毒的病理生理、对母儿的影响、诱发因素、预测因子、早期预警信号及预测模型等进行论述。     

妊娠糖尿病酮症酸中毒

妊娠糖尿病酮症酸中毒天津医科大学第二医院产科（３００２１１）李奕指导刘映磷妊娠期发生的糖尿病酮症酸中毒（ｄｉａｂｅｔｉｃｋｅｔｏａｃｉｄｏｓｉｓ，ＤＫＡ），是一种可危及母亲和胎儿生命的急性综合征。在妊娠合并糖尿病孕妇中发病率可达３％～２２％［１］。...     

护理干预对妊娠期糖尿病患者妊娠结局的影响

妊娠期糖尿病是指妊娠期发生或首次发现的糖尿病,常伴有明显的代谢紊乱,发病率为1%～5%[1]。妊娠期糖尿病属高危妊娠,是妊娠期常见的并发症,如得不到及时治疗,可出现一系列并发症及合并症,如孕妇可发生酮症酸中毒、妊娠期高血压疾病（妊高病）、感染和羊水过多等;也可出现巨大儿、死胎、早产、     

糖尿病酮症酸中毒并发脑水肿临床分析

目的探讨儿童糖尿病酮症酸中毒并发脑水肿的临床特征及危险因素。 方法对重庆医科大学附属儿童医院1993—2005年住院治疗的糖尿病酮症酸中毒并发脑水肿患儿的临床特征及病因进行分析，并与未并发者进行对照比较。 结果在71例酮症酸中毒患儿中，有6例临床表现符合脑水肿的诊断标准，临床确定为并发脑水肿，并发率为84%。6例均为重型酮症酸中毒。与未发生脑水肿同等程度的重型酮症酸中毒患儿相比较，并发脑水肿患儿酸中毒更为严重，在治疗期间血钠上升缓慢及持续低钠血症，尿素氮水平升高。6例患儿中有5例应用碳酸氢盐治疗，用量大于未并发者。 结论糖尿病儿童并发重型酮症酸中毒易发生脑水肿。严重酸中毒、血钠上升缓慢或持续低钠血症、血尿素氮升高及碳酸氢盐的使用有可能增加脑水肿发生的危险性。     

妊娠期糖尿病

妊娠期糖尿病是指在妊娠时才出现或发现糖尿病者。其发生率约33％。妊娠期内分泌素的增加使周围组织有抗胰岛素作用,而妊娠血液稀释使胰岛素相对不足,故孕期易发生糖尿病。且妊娠期糖尿病易发生酮症酸中毒、肾盂肾炎、羊水过多、妊娠高血压综合征、巨大胎儿、胎儿畸形及死胎,而新生儿易发生呼吸窘迫综合征、低血糖、低血钙及红细胞增多症。妊娠期糖尿病与妊娠前已患糖尿病即糖尿病合并妊娠,这两个概念是有区分的,后者在妊娠前应对糖尿病给予良好的控制,且大部分是胰岛素依赖型,并曾接受胰岛素的治疗。     

妊娠糖尿病并发酮症及酮症酸中毒的诊断与处理

妊娠糖尿病并发酮症及酮症酸中毒时对母儿健康危害较大，尤其当发生糖尿病酮症酸中毒(diabetic ketoacidosis，DKA)，如不及时抢救或处理不当，则孕产妇死亡率高且围产儿死亡率亦高达35％。现将我院近年来收治的妊娠糖尿病并发酮症及酮症酸中毒8例，分析报道如下。     

妊娠期糖尿病酮症酸中毒的处理

妊娠期糖尿病酮症酸中毒是一种少见的产科危重症,是以高血糖、高血酮、严重脱水和代谢性酸中毒为主要临床表现的一种综合征,若治疗不及时则母婴死亡率及病率明显升高。及时给予紧急补充血容量,同时辅以胰岛素补充治疗。病情多能快速缓解,母儿预后良好。     

48例糖尿病酮症酸中毒及昏迷的临床治疗分析

目的：探讨糖尿病酮症酸中毒及其昏迷的发病原因及临床治疗的效果;方法：收集近年来我院收治的48例糖尿病酮症酸中毒厦昏迷患者治疗情况的临床资料,并根据患者不同的年龄结构分成两组进行分析研究,探讨糖尿病酮症酸中毒及昏迷患者入院治疗的临床效果;结果：48例糖尿病酮症酸中毒及昏迷患者经过入院定期观察治疗,病灶得到缓解;结论：糖尿病酮症酸中毒及昏迷患者中以中老年人,尤其是老年人居多,发病的患者要坚持长期补充血容量,坚持用胰岛素治疗,并纠正电解质厦酸碱平衡失调。对于轻微患者要早诊断,早发现,早治疗,防止发生并发症,通过合理治疗并坚持锻炼身体病情会得到缓解。     

糖尿病孕妇的分娩期处理

妊娠合并糖尿病是妊娠期间发现或发病的由不同程度糖耐量异常及糖尿病引起的不同程度的高血糖。包括妊娠前即存在的和随妊娠期而发生的两种情况。美国妊娠期糖尿病（GDM）发生率为2％-5％，我国GDM的发生率为1％～5％。妊娠糖尿病可使子癎前期、羊水过多、难产、产后出血、巨大儿、胎儿畸形、死胎、死产，新生儿呼吸窘迫综合征、低血糖等发生率增加，若血糖控制不良，易发生酮症酸中毒。分娩使糖尿病孕妇代谢和免疫功能受到影响，增加了糖尿病孕妇及胎儿的危险陛。     

给“糖妈妈”的几点建议

无论是已患糖尿病的怀孕,还是妊娠期间首次发现血糖升高,只要血糖异常就会对孕妇和胎儿造成不良的影响。如孕妇发生妊娠高血压综合征、羊水过多、早产、流产、泌尿生殖系统感染、酮症酸中毒及高渗性昏迷的风险会明显增大,畸形胎儿和巨大胎儿发生率也会明显升高。     

妊娠合并系统性红斑狼疮的围孕期管理

妊娠合并系统性红斑狼疮（systemic lupus erythematosus,SLE）属于高危妊娠,容易出现母婴不良结局。选择适宜的妊娠时机,孕期合理用药,多学科共同监测母儿情况,规范和加强对SLE患者的妊娠管理,适时终止妊娠,可以改善妊娠结局。     

体外受精/卵胞质内单精子显微注射双卵双胎减胎后妊娠结局的病例对照研究

目的探讨双卵双胎妊娠早期减胎为单胎的妊娠结局。方法 2008年1月—2014年12月期间体外受精及卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)后双胎妊娠早期(孕45~75 d)减胎为单胎者102例(A组),三胎妊娠早期减胎为双胎者73例(B组)以及双胎妊娠未减胎者4 638例(C组),比较其中晚期流产率、早产率等进一步的妊娠结局。结果 IVF/ICSI-ET后A组与B组和C组比较,早产率(10.8%,58.6%,42.1%)、低出生体质量儿率(6.8%,44.1%,30.3%)明显降低,孕周[(38.0±2.0)周,(35.7±2.3)周,(36.4±2.1)周]、出生体质量[(3.17±0.53)kg,(2.51±0.59)kg,(2.69±0.53)kg]明显增加,差异有统计学意义(P0.05),中晚期流产率差异无统计学意义(P0.05)。结论 IVF/ICSI后的双卵双胎妊娠,于孕早期行减胎术安全,具有更好的妊娠结局。     

Pre-eclampsia in second pregnancy

A total population of pregnant women from Aberdeen City District 1967-1978 has been studied. There were 29 851 pregnancies and 6637 women had a first recorded pregnancy between 1967 and 1978 and had two or more pregnancy events. As expected the incidence of pre-eclampsia in a second pregnancy was less than that in a first pregnancy, but it was dependent on the outcome of the first pregnancy. If the first pregnancy was complicated by proteinuric pre-eclampsia than the incidence of the condition in the second pregnancy was similar to that in a first pregnancy, but women who were normotensive in the first pregnancy had a reduced incidence of the condition in the second pregnancy. The incidence of proteinuric pre-eclampsia after early abortion (less than 13 weeks), either spontaneous or induced was similar to the population incidence in a first pregnancy, but after a late spontaneous abortion the risk of proteinuric pre-eclampsia was significantly reduced. Change of civil status of the offspring from first to second pregnancy did not affect the incidence of pre-eclampsia in a second pregnancy. There was an effect of birthweight in that women who had proteinuric pre-eclampsia in conjunction with a low-birthweight baby (less than 2500 g) in their first pregnancy had double the incidence of proteinuric pre-eclampsia in their second pregnancy. Only a pregnancy of 37 weeks or more is likely to offer protection or 'immunity' to pre-eclampsia in a second pregnancy and even then the effect is moderated by the development of pre-eclampsia in the first pregnancy.     

Pre-eclampsia in second pregnancy

Summary. A total population of pregnant women from Aberdeen City District 1967–1978 has been studied. There were 29 851 pregnancies and 6637 women had a first recorded pregnancy between 1967 and 1978 and had two or more pregnancy events. As expected the incidence of pre-eclampsia in a second pregnancy was less than that in a first pregnancy, but it was dependent on the outcome of the first pregnancy. If the first pregnancy was complicated by proteinuric pre-eclampsia than the incidence of the condition in the second pregnancy was similar t o that in a first pregnancy, but women who were normotensive in the first pregnancy had a reduced incidence of the condition in the second pregnancy. The incidence of proteinuric pre-eclampsia after early abortion <13 weeks), either spontaneous or induced was similar to the population incidence in a first pregnancy, but after a late spontaneous abortion the risk of proteinuric pre-eclampsia was significantly reduced. Change of civil status of the offspring from first to second pregnancy did not affect the incidence of pre-eclampsia in a second pregnancy. There was an effect of birthweight in that women who had proteinuric pre-eclampsia in conjunction with a low-birthweight baby (<2500g) in their first pregnancy had double the incidence of proteinuric pre-eclampsia in their second pregnancy. Only a pregnancy of 37 weeks or more is likely to offer protection or 'immunity' to pre-eclampsia in a second pregnancy and even then the effect is moderated by the development of pre-eclampsia in the first pregnancy.     

体外受精-胚胎移植技术中74例异位妊娠的临床分析

目的:分析体外受精-胚胎移植(in vitro fertilization and embryo tranfer,IVF-ET)助孕技术中发生异位妊娠的影响因素、诊断、治疗方法及预防措施。方法:回顾性分析IVF-ET助孕技术中发生异位妊娠74例患者的临床资料。结果:所有接受IVF-ET的1 585患者中,共发生异位妊娠74例,异位妊娠发生率为4.67%;异位妊娠类型中输卵管妊娠71例,占总异位妊娠的95.95%。新鲜胚胎移植周期组异位妊娠发生率(5.41%)显著性高于冷冻胚胎复苏移植(frozing embryo transfer,FET)周期组(2.35%)(P<0.05)。移植深度距离宫底>1.2 cm时异位妊娠发生率显著性低于移植深度0.8~1.2 cm组。结论:IVF-ET助孕技术中异位妊娠发生率较自然妊娠过程中高;输卵管因素、促排卵药物的应用以及胚胎移植的深度是异位妊娠发生的主要影响因素。     

Optimal timing of periodontal disease treatment for prevention of adverse pregnancy outcomes: before or during pregnancy?

Several large randomized controlled clinical trials failed to find that standard periodontal therapy during pregnancy reduces the incidence of adverse pregnancy outcomes (eg, preterm birth and low birthweight). However, treating periodontal disease during pregnancy may be too late to reduce the inflammation that is related to the adverse pregnancy outcomes. Moreover, periodontal treatment during pregnancy can cause bacteremia, which itself may initiate the pathway leading to the adverse pregnancy outcomes. Finally, the periodontal treatments provided during pregnancy are not always effective in preventing the progression of periodontal disease during pregnancy. Pregnancy may not be an appropriate period for periodontal intervention(s). We hypothesize that periodontal treatment before pregnancy may reduce the rates of adverse pregnancy outcomes. Future randomized controlled trials are needed to test if treating periodontal disease in the prepregnancy period reduces the rate of adverse pregnancy outcomes.     

妊娠合并宫颈癌的治疗策略

妊娠合并宫颈癌的治疗策略包括妊娠期宫颈癌的筛查,以及确诊后妊娠期宫颈癌的处理原则。对于妊娠合并宫颈低级别病变可以延迟到产后随访;对于妊娠合并宫颈高级别病变,在除外浸润癌后,可以在妊娠期间定期随访,并延至在产后复查。对已确诊的妊娠合并宫颈癌,在征得患者及家属的知情同意后,可以采取不保留胎儿或继续妊娠的治疗。由于妊娠合并宫颈癌多为个案报道,需要积累更多的前瞻性资料进行研究。     

多胎妊娠孕期母儿监护

多胎妊娠不仅常见的孕期并发症如妊娠期高血压疾病、妊娠期肝内胆汁淤积症、胎膜早破、早产、胎儿畸形等的发病率高于单胎,而且还存在很多其特有的母儿并发症,孕产妇和围产儿死亡率显著增加。多胎妊娠的早期诊断、规范的孕期管理和监护对改善不良妊娠结局具有重要意义。     

A case of a cornual heterotopic pregnancy laparoscopically treated with the endoloop technique

Heterotopic pregnancy is defined as the coexistence of an intrauterine and an ectopic pregnancy. The estimated incidence is one in 30,000 spontaneous pregnancies, with a tenfold increase in women who underwent assisted reproductive technologies. Diagnosis of a heterotopic pregnancy is often delayed because of the presence of the intrauterine gestational sac. Treatment of a heterotopic pregnancy should consist of termination of the ectopic pregnancy without damaging the ongoing intrauterine pregnancy. The least invasive procedure should therefore be used. We present a case of a heterotopic pregnancy consisting of a viable intrauterine pregnancy and an ectopic cornual pregnancy. Because of the viable intrauterine pregnancy, we decided to treat the cornual pregnancy laparoscopically by the endoloop technique. This technique is simple, safe, effective and nearly bloodless. It offers a good prognosis for the ongoing intrauterine pregnancy.