范永升教授治疗系统性红斑狼疮合并高危妊娠1例

A Case of Systemic Lupus Erythematosus Combined with High-risk Pregnancy Treated by Professor FAN Yongsheng

[目的]分析范永升教授治疗系统性红斑狼疮(systemic lupus erythematosus,SLE)合并妊娠的临床用药经验,总结中西医结合治疗SLE妊娠的规律。[方法]通过报道1例SLE患者备孕期,妊娠早、中、晚期以及产后期的临床表现和诊治过程,分析其所处妊娠不同阶段的病因病机及临床用药规律,总结范永升教授治疗SLE合并妊娠的临床用药经验。[结果]该例育龄期患者SLE患病多年,长期使用糖皮质激素及免疫抑制剂治疗。备孕期患者肝脾不和,予疏肝健脾治疗后成功妊娠。妊娠早期患者出现先兆流产,在西医治疗基础上配合中药滋阴清热、疏肝健脾、和胃安胎;妊娠中期皮疹复发,予疏风清热、养血安胎为治;妊娠晚期胎水肿满,经健脾利水、疏风清热安胎等治疗后患者顺利分娩。产后瘀血阻滞,以养血祛瘀、调和肝脾为治。[结论]SLE合并妊娠属于高危妊娠,中西医结合治疗不仅可稳定SLE病情,还可以有效改善妊娠结局。SLE患者围妊娠期中医病因病机复杂,临床治疗需病证结合,辨证论治,随证治之。

[Objective]To analyze the clinical medication experience of Professor FAN Yongsheng in the treatment of systemic lupus erythematosus(SLE)combined with high-risk pregnancy,and to summarize the general rules of integrative Chinese and western medicine in the treatment of SLE with pregnancy.[Methods]Through reporting the clinical manifestations,diagnosis and treatment process of a case of SLE patient during before pregnancy,early,middle and late pregnancy,and postpartum,this article analyzed the etiology and pathogenesis as well as the clinical medication rules during the different stages of pregnancy,sequentially summarized the clinical medication experience of Professor FAN Yongsheng in the treatment of SLE with pregnancy.[Results]The childbearing age patient with SLE for many years had been treated with glucocorticoids and immunosuppression chronically.Before pregnancy,the patient was differentiated as disharmony between the liver and spleen,and succeeded in pregnancy after using the method of soothing the liver and strengthening the spleen.In the first trimester of pregnancy,Chinese medicine was used on the basis of western medicine treatment to nourish Yin and clear heat,soothe the liver and strengthen the spleen,regulate the stomach and protect pregnancy because of the threatened miscarriage.Recurrence of rash in the second trimester was treated by dispelling wind and clearing heat,nourishing blood and preventing abortion.In the third trimester of pregnancy,the patient suffered from polyhydramnios,and finally successfully delivered after the treatment of strengthening the spleen and diuresis,dispelling wind and clearing heat and protecting pregnancy.In Postpartum,with accumulation of blood stasis,treatment of invigorating blood and eliminating stasis and harmonizing the liver and spleen was adopted.[Conclusion]Although SLE combined pregnancy is a high-risk pregnancy,integrative medicine therapy can not only stabilize SLE disease,but also effectively improve pregnancy outcomes.Because the etiology and pathogenesis of traditional Chinese medicine in SLE with pregnancy are complicated,the clinical treatment requires integration of disease and symptoms,treatment methods should be selected according to syndromes.