系统性红斑狼疮患者妊娠与分娩过程处理的初步探讨

目的 探讨系统性红斑狼疮(SLE)患者的妊娠时机、妊娠期并发症处理、终止妊娠时机、分娩过程中及娩后治疗问题。方法 前瞻性地观察29例SLE患者妊娠结果，其中23例患者病情控制1年以上妊娠。2例妊娠前1年内有病情活动，4例妊娠期首发SLE。结果 10例发生妊娠高血压综合征，6例妊娠晚期伴发心力衰竭．3例妊娠晚期伴发广泛性肺间质炎。29例患者均于孕30～37周终止妊娠，出生婴儿29名．无新生儿狼疮．无母婴死亡。6例分娩后狼疮加重。结论 SLE患者病情控制1年以上妊娠母婴安全度显著提高．疾病活动、妊娠过程及产后适当应用激素控制并发症是成功的关键，有并发症者应适时终止妊娠以确保母婴安全。

The study on the rational management of patients with systemic lupus erythematosus during pregnancy and delivery

Objective To study the pregnancy opportunity,treatment of complications,time of ending pregnancy and treatment during and after pregnancy in patients with systemic lupus erythematosus(SLE).Method Prospective study on pregnant patients with SLE was carried out between 2000 and 2003 in Qingdao Municipal Hospital.There were total 29 patients enrolled,all which didn't have cytotoxic drugs at least six months before conception,among whom 23 patients'disease were under control over one year and had low-dose glucocorticoids before pregnancy,two had disease activity under control by mid-and high-dose glucocorticoids within one year and have been pregnant without the direction of the doctor,four new onset during the pregnancy.Results All patients had flares during pregnancy or had multi-complications,10 cases had pregnancy hypertension syndrome,six cases had heart failure during the late pregnancy,three had extensive interstitial lung disease during the late pregnancy.All patients stopped the pregnancy at 30~37 weeks,the total 29 live infants had neither neonatal lupus nor maternal-fetal death.Conclusion The maternal-fetal safety can be increased significantly when disease activity was controlled over one year.Glucocorticoids should be applied when disease flared during pregnancy and postpartum is the key of success,Stop as pregnancy when there are complications in order to improve maternal-fetal safety.