30例危重症肺结核孕产妇的临床特征及预后分析

The clinical features and prognostic analysis of 30 pregnant or parturient women with severe tuberculosis

为了解发生危重症肺结核孕产妇的临床特征及预后情况,笔者搜集成都市公共卫生临床医疗中心结核科重症病区2013年1月至2018年6月收治的30例发生危重症肺结核孕产妇(孕妇21例,产妇9例)的临床资料进行分析。结果显示,患者症状以发热(90.0%,27/30)、气促(86.7%,26/30)、咳嗽(76.7%,23/30)多见;结核病类型以血行播散性肺结核为主(73.3%,22/30),33.3%(10/30)并发肺外结核。30例患者中,11(36.7%)例行体外受精-胚胎移植(IVF-ET)术;患者院内死亡4例,2例病情恶化自动出院后电话随访死亡;9例产妇院外分娩活婴,14例孕妇引产或流产,4例孕妇院内分娩活婴,3例孕妇继续妊娠。综上,发生危重症肺结核孕产妇的临床表现缺乏特异性,以血行播散性肺结核为主,应及时诊断、规范治疗以改善预后;同时,建议拟行IVF-ET术的妇女行结核病相关项目的筛查。

To investigate the clinical features and prognosis of the pregnant or parturient women with severe tuberculosis,the clinical data of 30 patients(21 pregnant women and 9 parturients)with severe tuberculosis admitted to the tuberculosis department of the Urban Public Health Clinical Medical Center from January 2013 to June 2018 were collected and analyzed in this study.The results showed that the symptoms of patients were fever(90.0%,27/30),shortness of breath(86.7%,26/30),and cough(76.7%,23/30).Hematogenous pulmonary tuberculosis was the most common form(73.3%,22/30)of tuberculosis,and 33.3%(10/30)of the patients were complicated with extrapulmonary tuberculosis.Of the 30 patients,11(36.7%)patients underwent in vitro fertilization-embryo transfer(IVF-ET);4 patients died in the hospital,2 patients died by phone follow-up after being discharged;9 parturients gave birth to live babies outside the hospital,14 cases of pregnant women induced labor or abortion,4 cases of pregnant women delivered successfully in our hospital,and 3 cases of pregnant women continued pregnancy.In conclusion,the pregnant or parturient women in severe tuberculosis are lack of typical clinical manifestations,mainly with hematogenous pulmonary tuberculosis.Timely diagnosis and standardized treatment should be made to improve the prognosis.Meanwhile,tuberculosis screening is recomnended for women who plan to undergo IVF-ET.