癫痫合并妊娠36例临床特点分析

An analysis on clinical characteristics of 36 epileptics with pregnancy

目的 分析癫痫合并妊娠的临床特点,为癫痫合并妊娠患者的规范化管理提供参考依据。方法 收集2012年6月—2021年6月在济南市中心医院产科分娩的癫痫合并妊娠患者的临床资料,分析患者妊娠期间抗癫痫发作药物(Antiseizure medications,ASMs)应用情况、癫痫发作频率变化、妊娠结局、分娩方式、子代喂养方式以及并发症的发生情况。结果 纳入患者36例,其中妊娠期间单用ASMs治疗20例(55.56%)、联合用药治疗5例(13.88%)、未服用11例(30.56%)。坚持系统应用ASMs者15例(41.67%)、未坚持系统用药者17例(47.22%)、用药史不详者4例(11.11%)。妊娠期癫痫发作频率增加5例(13.89%)、癫痫发作频率减少7例(19.44%)、癫痫发作频率不变24例(66.67%)。妊娠结局:足月产33例(91.67%)、早产1例(2.78%)、流产2例(5.55%);分娩方式:剖宫产31例(91.18%)、阴道分娩3例(8.82%)。分娩后奶粉喂养4例(11.76%)、母乳喂养30例(88.24%)。并发症:贫血6例(16.67%)、妊娠期高血压5例(13.89%)、妊娠期糖尿病3例(8.33%)、胎膜早破4例(11.11%)、胎儿生长受限2例(5.56%)、羊水过少2例(5.56%)、胎儿窘迫3例(8.33%)、新生儿窒息3例(8.33%)。结论 癫痫合并妊娠患者系统应用ASMs治疗者比例低,癫痫发作控制不佳,临床上对于该类患者缺乏规范化管理。

Objective To investigate the clinical characteristics of epileptics with pregnancy and then provide reference for standardized management of epileptics with pregnancy.Methods From June 2012 to June 2021,epileptics with pregnancy who delivered in Jinan Central Hospital were selected as the research subjects.The clinical data such as the application of Antiseizure medications(ASMs) during pregnancy,seizure frequency,pregnancy outcomes,delivery ways,offspring feeding ways and the incidence of complications were investigated and analyzed.Results Among 36 epileptics with pregnancy,20 cases(55.56%) were treated with ASMs alone,5 cases(13.88%) were treated with combined medication,and 11 cases(30.56%) were treated without ASMs during pregnancy.15 cases(41.67%) adhered to systematic application of ASMs,17 cases(47.22%) did not adhere to systematic application of ASMs,and 4 cases(11.11%) had unknown medication history.The frequency of seizures increased in 5 cases,decreased in 7 cases and unchanged in 24cases during pregnancy.Pregnancy outcomes:full-term delivery in 33 cases(91.67%),preterm delivery in 1 case(2.78%)and abortion in 2 cases(5.56%).Delivery mode:cesarean section in 31 cases(91.18%),vaginal delivery in 3 cases(8.82%).After delivery,4 cases(11.76%) were fed with milk powder and 30 cases(88.24%) were breast-fed.Complications:There were 6 cases complicated with anemia(16.67%),5 cases complicated with gestational hypertension(13.89%),3 cases complicated with gestational diabetes(8.33%),4 cases complicated with premature rupture of membranes(11.11%),2cases complicated with fetal growth restriction(5.56%),2 cases complicated with oligohydramnios(5.56%),3 cases complicated with fetal distress(8.33%) and 3 cases complicated with neonatal asphyxia(8.33%).Conclusions The proportion of epileptics with pregnancy who were systematically treated with ASMs was low and the seizures were poorly controlled.There is a lack of standardized management for such patients in clinical practice.