妊娠合并甲状腺机能亢进症67例临床分析

Pregnancy combined with hyperthyroidism: analysis of 67 cases

目的:探讨妊娠合并甲状腺功能亢进的临床特点及处理原则。方法:回顾性分析11年间妊娠合并甲状腺功能亢进症67例患者的资料,按照正规治疗与否分为对照组30例和治疗组37例。结果:①治疗组患者甲状腺激素水平与对照组比较差异有统计学意义(P<0.05)。②妊娠结局:两组新生儿平均体重、1min Apgar评分比较,差异有统计学意义(P<0.05)。③分娩方式:治疗组患者阴道分娩19例,剖宫产18例;对照组患者经阴道产钳助娩1例,剖宫产19例,阴道分娩10例。④并发症:对照组中10例患者合并妊娠期高血压疾病(其中子痫前期4例),6例患者合并心功能不全,2例患者发生甲状腺危象。治疗组中1例患者同时合并子痫前期。结论:①孕期病情得到控制的患者可视同正常妊娠;②产时及产后防止心功能不全和甲状腺危象;③中、重度妊娠合并甲状腺功能亢进症适当放宽剖宫产指征。妊娠合并甲状腺功能亢进症常危及母婴健康,为降低母儿风险,孕前需很好地控制病情,孕期密切监控,合理治疗。

Objetive To evaluate the clinical characteristes and treatment of hyperthyroidism in pregnancy. Method Medical records of 67 cases with hyperthyroidism during pregnancy in our hospital and nanhua hospital of nanhua university over a period of 11 years were reviewed. Sixty - seven cases were divided into two groups according to therapy records, one group （ n = 37） with standard treatment as the treatment group, the other group （ n = 30） without standard treatment as the control group. Results （2）Compared with the treatment group, the serum levels of FT4/FT3 in the control group were significantly higher and the serum levels of TSH were significantly lower （ P 〈 0.01 ）. （2）Pregnant outcome ： The mean newborn weight and one minute Apgar score after delivery in the control group were significantly lower than that of the treatment group （ P 〈 0.05 ）. （3）Delivery way ： In the control group, 1 case was delivered with force ps, 9 cases were delivered by caesarean section. In the treatment group, 19 cases delivered through vagina, 18 cases were delivered by caesarean - section. （~Complications：In the control group, 10 cases were incorporated with pregnancy -induced hypertention （4 of preeclampsia） , 6 cases with cardiac failure, 2 cases with thyrointoxication. In the treatment group, only 1 case was complicated with preeclampsia. Conclusion （1）Mild hyperthyroidism patients during pregnancy should be managed as normal if treated properly and promptly. （2）Heart failure and thy- rointoxieation must be prevented in labor and after delivery. （3）Pregnancy combined with hyperthyroidism often endangers maternal and neo- natal health. Therefore, for reducing the risks, before pregnancy, the patients＇ conditions should be well controlled; during pregnancy, gravida should be closely paid more attention to and treated reasonably.