妊娠合并脊髓损伤的孕期康复及产科处理(附4例报告)

The rehabilitation and treatment for Pregnancy with spinal cord injury during pregnancy(clinical analysis of 4 csaes

目的探讨妊娠合并脊髓损伤的孕期康复及处理。方法总结在我院检查并分娩的4例妊娠合并脊髓损伤者的临床资料,对所有患者治疗前进行Barthel指数评分、汉密尔顿焦虑量表评分、汉密尔顿抑郁量表评分,结合文献讨论其孕期康复、分娩及产后管理。结果 4例妊娠合并脊髓损伤病例,均为初次妊娠,年龄27～33岁,分娩孕周为35＋周～38周,脊髓损伤平段T8-T10,4例孕期均有尿失禁、便秘,2例孕期轻中度贫血,1例合并胎儿生长受限,1例合并妊娠期糖尿病。3例胎膜早破,2例早产。3例全麻下行子宫下段剖宫产术,1例产钳助产分娩。4例新生儿1min Apgar评分均为10分,体重2 350～3 350 g。经过孕期系统康复训练Barthel指数、汉密尔顿焦虑量表评分、汉密尔顿抑郁量表评分的各项指标有明显改善。结论妊娠合并脊髓损伤患者孕期应坚持心理疏导及康复训练,在多学科团队,特别是产科医生与康复医学科、麻醉科医师的密切协作下,通常有良好的妊娠结局;但要警惕早产、自主神经反射异常的风险。

Objective To explore the management of rehabilitation and treatment of pregnancy with spinal cord injury. Methods From 2012 to 2015, we retrospectively reviewed cases admited to department of Obstetrics and Gynecology in Xuanwu hospital, Capital Medical University and the clinical data of 4 cases of pregnancy with spinal cord injury collected. All the patients were scored with Hamilton Anxiety Scale, Hamilton depression scaleand the Barthel index before taking treatment. We reviewed the literature on its rehabilitation,pregnancy,delivery and postnatal management. Results All these 4 cases were pregnancy with spinal cord injury for the first pregnancy, their age ranged from 27 to 33 years old,the gestational age was 35＋～38 weeks, and the spinal cord injury was below T8-T10. They had urinary incontinence, constipation, 2 patients had mild-to-moderate anemia during pregnancy, 1 patients had fetal growth retardation, 1 case had gestational diabetes. Three cases were premature rupture of membranes, including 2 cases of preterm labor. Three cases had cesarean section under general anesthesia, 1 patient had midwifery forceps. Four delivery had neonatal Apgar score for 10 points at 1 minute,the body weight was 2 350～3 350 g. After pregnancy rehabilitation,anxiety and depression index, Barthel index were improved significantly. Conclusion Patients who are pregnant with spinal cord injury should adhere to the psychological counseling and rehabilitation training. Normally, it will achieve good results with multidisciplinary team, especially under close cooperation with the obstetrician, rehabilitation physician and anesthesiologist. But be aware of the preterm birth, infection, and the autonomic dysreflexia risk.