妊娠合并重症肌无力

该文就妊娠与重症肌无力之间的相互关系进行了阐述,并介绍了重症肌无力患者的妊娠管理,为育龄期重症肌无力妇女的孕前指导、孕期保健及治疗提供临床指导.     

妊娠期重症肌无力对母儿的影响及诊治

重症肌无力(myasthenia gravis,MG)常发生在20～45岁的育龄女性,病情变化常难以预测。妊娠合并MG轻症者可考虑继续妊娠,重症者应终止妊娠。妊娠期间应加强监护,维持病情的稳定,确保母亲及胎儿的安全。妊娠期间用药是安全的,临床常用的药物有抗胆碱酯酶药、免疫抑制剂和免疫球蛋白等。MG不是剖宫产的指征,可经阴道自然分娩。新生儿可能会出现一过性的肌无力,但往往是暂时的。     

妊娠合并重症肌无力的临床研究进展

重症肌无力（myasthenia gravis,MG）是神经-肌肉接头传递障碍并以骨骼肌无力为特征的自身免疫性疾病。妊娠合并MG可使病情发生难以预测的变化。妊娠妇女MG病情、治疗方案对胎儿、新生儿、甚至子代的远期存在一定影响。MG与妊娠、分娩、麻醉等过程存在相互作用。妊娠期用药应采取个体化治疗方案;MG病情控制良好的妊娠妇女仅在有产科指征时方可考虑剖宫产术,阴道分娩则应尽可能缩短第二产程。 MG妊娠妇女的围生期治疗需要特殊关注。综述如上问题的研究进展。     

系统健康教育对重症肌无力病人的护理干预

目的通过系统的健康教育提高病人的遵医依从性,建立良好的生活方式,减少复发提高生活质量。方法 134例MG随机分组进行系统健康教育及常规组健康教育结果对照组病人的依从性、病情,均优于常规组结论系统健康教育能有效改善重症肌无力患者的心理状态,改变不良行为,提高自我保健能力减少复发次数     

54例小儿重症肌无力临床诊疗分析

目的:分析比较胸腺切除与药物治疗儿童型重症肌无力(MG)的临床疗效。方法:收集我院54例小儿重症肌无力患者的临床资料,随机分成胸腺切除组和药物治疗组,每组27例,比较分析不同性别、年龄、病程、临床分型对两种不同治疗方案临床疗效的影响。结果:1年内药物治疗组症状完全缓解8例(29.6%),症状改善7例(25.9%),总有效率为55.6%;胸腺切除组症状完全缓解11例(40.7%),症状改善8例(29.6%),总有效率为70.4%,两组间完全缓解率和总有效率差异无统计学意义(P>0.05)。两组治疗有效患者性别构成、年龄以及病程无统计学差异(P>0.05)。讨论:药物应为对因治疗的首选,对于药物难以控制病例可考虑采用胸腺切除手术治疗。     

妊娠中晚期合并重症急性呼吸综合征的临床分析

目的 探讨与分析妊娠中晚期合并重症急性呼吸综合征(SARS)患者的临床特点及母婴预后。方法 对我院2003年2月4日—3月17日收治的妊娠中晚期合并SARS5例患者的临床资料进行回顾性分析。结果 (1)5例妊娠中晚期合并SARS(其中双胎妊娠2例)患者均为初产妇,孕中期发病2例,孕晚期发病3例;院内感染3例,社区感染2例。(2)5例患者均有发热(5／5),其中高热3例、低热2例,畏寒或寒战3例,咳嗽4例。(3)外周血淋巴细胞减少2例,血小板减少2例,肝酶升高3例,低蛋白血症4例,X线胸片阴影5例。(4)5例患者经对症治疗均已痊愈出院。(5)剖宫产3例、阴道产1例,共分娩新生儿5例(包括双胎1例),新生儿随访至今无SARS感染。1例双胎妊娠患者,一胎宫内死亡,另一胎儿现在观察中,情况尚稳定。结论 妊娠中晚期合并SARS患者的母婴预后尚好,但应注意妊娠期特殊的生理变化与SARS的相互影响。重症者宜适当放宽剖宫产指征,对降低母婴死亡率十分重要。     

妊娠合并重症肝炎的诊断与治疗

妊娠合并肝病严重危及母儿生命安全 ,据全国孕产妇死因调研协作组 1991年报道 ,要占我国孕产妇死因顺位第6位。肝病中以病毒性肝炎较为多见 ,其发生率国内外报道不一 ,约为 0 0 8%～ 17 8%不等 ,孕产妇病死率较高 ,武汉地区曾报道妊娠合并病毒性肝炎 6 0例 ,孕产妇病死率高达 18 2 % [1] 。病毒性肝炎的分类通常根据病原学及临床表现来确定 ,按病原学可分为甲、乙、丙、丁及戊型肝炎 ;按临床表现又可分为急性、慢性及重症肝炎。早期公认的五种肝炎病毒均能引起重症肝炎 ,且多发生于妊娠晚期 ,其中乙型 ,尤其是乙型与丙型 ,乙型与丁型肝炎病…     

妊娠合并重症肝炎的诊断及急救策略

妊娠合并重症肝炎严重影响母婴健康,早期诊断、及时处理对降低母婴死亡率意义重大。治疗上应以个体化治疗为原则,给予相应综合治疗后根据孕产妇及胎儿情况选择适当时机终止妊娠。     

Myasthenia gravis and pregnancy

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular junction that has higher incidence in younger women than men, which could be related to differences in sex hormones physiology and immune system functioning between males and females. MG can first present during pregnancy and variably affect pregnancy, labor, and postpartum period. In this paper, we had an updated overview on our understanding about MG presentation and its effect on pregnancy and vice versa, therapeutic options for MG pregnant women, management of pregnancy or labor complications in MG patients, and finally fetal and neonatal considerations in MG pregnant women. A multidisciplinary approach, involving obstetricians/gynecologists, neurologists, and anes-thesiologists, plays a pivotal role in improving the clinical outcomes in both MG mothers and their infants during pregnancy, delivery and postpartum.     

晚期妊娠合并重型肝炎的产科处理

妊娠合并重型肝炎病死率高,其救治仍是产科一大难题。对于晚期妊娠合并重型肝炎,现阶段应强调早期识别和集中救治,在产前、病情较轻尚未发展到重型肝炎前及时转运到有条件的医院诊治其预后较好;应积极治疗,待重型肝炎病情有所控制后选择适当时机及时终止妊娠;在分娩方式方面,剖宫产同时行子宫次全切除预后较好。     

Neurological disease in pregnancy

Neurological disease encompasses a broad spectrum of conditions which may be affected by pregnancy, present de novo in pregnancy, or are caused by the pregnancy itself. Neurological diseases remain the second most common cause of indirect maternal deaths in the UK. It is imperative that a thorough history and examination are performed when assessing pregnant women presenting with neurological conditions, and that early specialist advice is sought. Multidisciplinary team working is also integral when caring for these women. These points are highlighted with the aid of case studies, with a particular focus on epilepsy, headaches, stroke, multiple sclerosis and myasthenia gravis in pregnancy.     

妊娠期贫血及其规范管理

贫血是妊娠期常见的内科合并症,影响着全球5600万的妊娠期妇女的健康,其中2/3来自亚洲,是围生期预防保健的重要内容。妊娠期血容量的增加与血浆及红细胞的增加不成比例是贫血多发的重要原因。其中,营养性贫血尤其是缺铁性贫血最为常见,目前最主要的防治方法是口服铁剂和注射铁剂补铁。同时,由于遗传缺陷引起的地中海贫血严重威胁着母儿的健康,故其预防、早期识别和相应的治疗措施对母儿的安全具有重要意义。     

Obstetric and perinatal management of myasthenia gravis

Three new cases of patients with myasthenia gravis during pregnancy are presented. The unpredictable course of myasthenia gravis (MG) in pregnancy is discussed. The course of labor in patients with MG is normal. The effects of certain drugs on the course of diseases are assessed. In our group of patients only one patient had an exacerbation of her MG after using an aminoglycoside. There were 7 live births. None of the newborns developed neonatal myasthenia.     

Respiratory disease in pregnancy

Physiological changes to the respiratory system in pregnancy make breathlessness a common symptom. However, it is still important to investigate symptoms of breathlessness to exclude pathological causes. This review illustrates some unusual cases of women presenting with breathlessness in pregnancy. Prompt recognition, investigation and management of these women is essential as delays can impact the mother and the neonate. Investigations should be used appropriately and not withheld or delayed due to pregnancy. Effects of respiratory conditions on pregnancy and the neonate are also discussed.