妊娠合并HIV孕妇围产期临床干预的探讨

The approach to the clinical intervention on the perinatal stage for the pregnant women with HIV infoofion

目的探讨有效阻断HIV母婴传播的干预模式。方法选择1999年7月至2006年12月收治的妊娠合并HIV孕妇67例，其中33例知情选择终止妊娠的孕妇口服米非司酮＋米索前列醇终止妊娠，34例选择继续妊娠的孕妇（其中4例为临产人院），通过孕期保健、同伴教育、服用抗逆转录病毒药物、择期剖宫产及产后新生儿人工喂养进行综合干预。结果选择终止妊娠33例成功流产／引产。34例全程接受干预处理孕妇，CD4＋水平明显上升．CD4／CD8比值上升，Hb水平无明显下降；HIV—RNAcopy明显下降。18个月新生儿HIVIgG检测，28例新生儿（2例未到时间）27例阴性，1例阳性；4例临产入院所生新生儿，2例阳性，1例阴性，1例失访。结论妊娠合并HIV孕妇，在围产期有效的干预措施下，不但能对HIV孕产妇进行有效管理，失访低，而且能有效阻断HIV母婴垂直传播。

Objective To study the effective model for prevention of HIV transmission from mothers to children.Methods Sixty-seven pregnant women with HIV infection were included. After counseling and companion education, there are 33 women elected to terminate the pregnancy, but 34 ones elected to continue the pregnancy. All patients were treated appropriately. Results 33 cases that erminate the pregnancy were completely aborted successfully.In the 34 cases who elected to continue the pregnancy, the levels of CD4＋ and the ratio of CD4＋/CD8＋ were raised, the level of hemoglobin was in the normal range, and the copies of HIV-RNA were reduced.Neonates were detected for HIV-IgG at the age of 18 months.Negative for IgG was found in 27 out of 28 neonates,and positive in 1 neonate.In 4 neonates whose mothers admitted to the hospital only after labor, 2 were detected to be positive for IgG, 1 negative and 1 lost to follow-up.Conolusions Effective management and reduced virus vertical transmission can be obtained for women with HIV infection by interventional approach.