妊娠合并精神障碍48例临床分析(1)
【摘要】 目的 探讨妊娠合并精神障碍患者的临床特点及处理策略。方法 收集48例妊娠合并精神障碍患者的临床资料，分析其发病年龄、孕次、孕周、终止妊娠方式及妊娠结局。 结果 48例妊娠合并精神障碍患者年龄集中于20～34岁(85%)，尤其23～30岁(63%)。初产妇(77%)比经产妇(23%)多见，且初次妊娠者(60%)多于再次妊娠者(40%)。住院患者孕周呈两极分布，以妊娠早期(尤其≤10周，占35%)及妊娠晚期(尤其≥37周，占38%)为主。48%患者的精神症状发作于妊娠早期。放弃妊娠29例、阴道分娩3例、剖宫产16例；共分娩新生儿19例，体质量2.5～4.3 kg，新生儿阿普加评分1 min 8～10分、5 min均10分，仅1例为早产儿。结论 产科医师应加强对妊娠合并精神障碍患者妊娠期及围生期处理的认识与关注，尤其注意年龄20～34岁、初次妊娠者的心理变化，及时发现异常，协同精神心理科医师积极处理，个体化选择终止妊娠方式，可取得较好的母胎结局。
【关键词】 精神障碍；妊娠；母胎结局
【Abstract】 Objective To investigate the clinical characteristics and therapeutic strategies for pregnant women complicated with mental disorder. Methods Clinical data of 48 pregnant women complicated with mental disorder were collected. The age of onset， gestational frequency， gestational age， method of pregnancy termination and pregnancy outcomes were analyzed. Results Forty-eight enrolled women were mainly aged from 20 to 34 years (85%)， and 63% between 23 and 30 years. The proportion of primipara women was 77%， significantly higher than 23% of multipara counterparts. The percentage of women with no medical history of pregnancy was 60%， considerably higher compared with 40% of their counterparts with pregnant history. A bipolar pattern of distribution was observed in terms of gestational age. The proportion of women with early pregnancy was 35%(especially≤10 weeks)and 38% for those with late pregnancy(especially≥37 weeks). 48% of mental disorders primarily occurred during the early pregnancy. Twenty-nine women terminated the pregnancy， vaginal delivery in 3 and cesarean section in 16. Among 19 newborns， the body weight was ranged from 2.5 to 4.3 kg. The 1-min Apgar score for newborns was from 8 to 10， and 10 for 5-min test. Only 1 preterm newborn was delivered. Conclusions Obstetricians should deepen the understanding of gestational and perinatal treatment for pregnant women complicated with mental disorder， especially those aged 20-34 years and with no pregnant history. Obstetricians should cooperate with the psychologists to adopt effective treatment for mental disorders， choose individualized approach of pregnancy termination and obtain favorable maternal and neonatal outcomes.
【Key words】 Mental disorder； Pregnancy； Maternal and neonatal outcome
精神障礙是指大脑机能活动发生紊乱，导致认知、情感、行为和意志等精神活动不同程度障碍的总称。妊娠作为女性一生中最特殊的生理阶段之一，可能伴随着一系列心理状态的急剧变化。文献指出，妊娠合并精神障碍发病率高达15% ～20%[1]。妊娠合并精神障碍主要包括抑郁症、躁狂症、双相情感障碍和精神分裂症4种，根据患者精神症状出现的时间，又可分为孕前患病治愈后妊娠时复发、孕前患病未控制持续至妊娠、孕前患病妊娠期需继续用药以及妊娠期首发4种。基于妊娠合并精神障碍对孕妇自身、胎儿以及周围人群均可能造成危害，早前已有学者提出，产科医师应重视妊娠合并精神障碍患者的孕期保健及围生期处理[2]。为了探讨妊娠合并精神障碍患者的临床特点及处理策略，本研究对近年我院收治的48例妊娠合并精神障碍住院患者临床资料进行回顾性分析，以期获得对临床有指导意义的结论，现报告如下。, http://www.100md.com(郭佩玲 张媛 戴丽珍 侯红瑛)
【关键词】 精神障碍；妊娠；母胎结局
【Abstract】 Objective To investigate the clinical characteristics and therapeutic strategies for pregnant women complicated with mental disorder. Methods Clinical data of 48 pregnant women complicated with mental disorder were collected. The age of onset， gestational frequency， gestational age， method of pregnancy termination and pregnancy outcomes were analyzed. Results Forty-eight enrolled women were mainly aged from 20 to 34 years (85%)， and 63% between 23 and 30 years. The proportion of primipara women was 77%， significantly higher than 23% of multipara counterparts. The percentage of women with no medical history of pregnancy was 60%， considerably higher compared with 40% of their counterparts with pregnant history. A bipolar pattern of distribution was observed in terms of gestational age. The proportion of women with early pregnancy was 35%(especially≤10 weeks)and 38% for those with late pregnancy(especially≥37 weeks). 48% of mental disorders primarily occurred during the early pregnancy. Twenty-nine women terminated the pregnancy， vaginal delivery in 3 and cesarean section in 16. Among 19 newborns， the body weight was ranged from 2.5 to 4.3 kg. The 1-min Apgar score for newborns was from 8 to 10， and 10 for 5-min test. Only 1 preterm newborn was delivered. Conclusions Obstetricians should deepen the understanding of gestational and perinatal treatment for pregnant women complicated with mental disorder， especially those aged 20-34 years and with no pregnant history. Obstetricians should cooperate with the psychologists to adopt effective treatment for mental disorders， choose individualized approach of pregnancy termination and obtain favorable maternal and neonatal outcomes.
【Key words】 Mental disorder； Pregnancy； Maternal and neonatal outcome
精神障礙是指大脑机能活动发生紊乱，导致认知、情感、行为和意志等精神活动不同程度障碍的总称。妊娠作为女性一生中最特殊的生理阶段之一，可能伴随着一系列心理状态的急剧变化。文献指出，妊娠合并精神障碍发病率高达15% ～20%[1]。妊娠合并精神障碍主要包括抑郁症、躁狂症、双相情感障碍和精神分裂症4种，根据患者精神症状出现的时间，又可分为孕前患病治愈后妊娠时复发、孕前患病未控制持续至妊娠、孕前患病妊娠期需继续用药以及妊娠期首发4种。基于妊娠合并精神障碍对孕妇自身、胎儿以及周围人群均可能造成危害，早前已有学者提出，产科医师应重视妊娠合并精神障碍患者的孕期保健及围生期处理[2]。为了探讨妊娠合并精神障碍患者的临床特点及处理策略，本研究对近年我院收治的48例妊娠合并精神障碍住院患者临床资料进行回顾性分析，以期获得对临床有指导意义的结论，现报告如下。, http://www.100md.com(郭佩玲 张媛 戴丽珍 侯红瑛)