精神病患者分娩期医疗方法探讨

Management of psychotic patient during labor

目的探讨精神病患者分娩期的医疗方法。方法回顾性分析了2001年1月至2005年9月收治的32例足月妊娠合并精神病患者的临床资料。结果17例发作期病人分娩时,13例给予保护性约束,10例行剖宫产术;15例稳定期病人中,13例妊娠中、晚期坚持服用抗精神病药物,新生儿未见畸形,4例进行了剖宫产术。18例阴道分娩的病人中,12例实行无痛分娩。新生儿出生后1 min阿氏评分正常者占93．8％(30／32);轻度窒息占6．2％(2／32);32例患者产科情况恢复良好。结论妊娠合并精神病患者,妊娠中、晚期应坚持服药;分娩时首先给予心理治疗和药物治疗,并配合镇痛分娩;对发作期病人可进行保护性约束,并适当放宽剖官产指征,可确保产妇和新生儿的安全。

Objective To explore better ways of management of patient with psychotic problems druing labor. Method Retrospective analysis of the clinical data of 32 cases with psychotic problems and having term prgenancy from january 2001 to September 2005. Results Of 17 cases with acute phase psychotic problems during laber,13 cases were recived protective restraint and 10 cases cesarean section. Of 15 cases with stable phase psychotic problems, no cases of birth defects were observed among 13 new- bores whose mothers took antipsychotics in second ＆ third trimesters of pregnancy, and 4 babies were de- livered through cesarean seciom. Among 18 cases with vagina delivery,12 cases were given pain-relief. Judged b Apgar score at 1 minutes after birth,30 eases （93.8 %）were normal and 2 eases （6.2 % ）were slight asphyxia. All 32 cases had good pregnancy outcomes. Conclusion Psychotic patient in second and third trimesters of pregnancy should continue to take antipsyehoties and be offered the psychotherapy during labor, while cooperated with labor analgesia and medication. The protective restraint may be used and indication for cesarean section a could be flexible for patients of acute aggravated phase to ensure the safety of woman and neonate.