肾移植术后妊娠的围生结局5例报告  

Perinatal outcome after renal transplantation in 5 cases

作　　者：李琳[1] 王淑珍[1] 翟妍[1] 李晓北[2] 

机构地区：[1]首都医科大学附属北京朝阳医院妇产科,100020 [2]首都医科大学附属北京朝阳医院泌尿外科,100020

出　　处：《北京医学》2008年第8期522-524,共3页Beijing Medical Journal

摘　　要：目的探讨肾移植患者的妊娠结局及其相关因素。方法回顾性分析我院2000年1月至2007年12月5例肾移植患者的6次妊娠,收集患者的产科资料、移植相关并发症、血肌酐水平、血压、分娩情况,随访新生儿、患者移植肾的结局。结果5例患者6例次妊娠,4例次期待妊娠,其中2例次妊娠成功,分别于孕37周及孕36周分娩,新生儿出生体重分别为3025g和3070g,新生儿无明显异常。2例次妊娠因重度子痫前期在孕中期行治疗性引产,其中1例受孕后降低免疫抑制剂的用量,引产术后两年肾功能进行性受损,1年后实施了对侧肾移植术;另1例患者受孕后停用免疫抑制剂,在孕中期出现重度子痫前期、心力衰竭、重度贫血、肾功能恶化,行治疗性引产。结论肾移植是生育年龄终末期肾脏疾病患者最好的治疗方式,但妊娠对于孕妇、胎儿、新生儿及移植肾都有一定的危险。孕期降低或停用免疫抑制剂是不良妊娠结局的重要原因。肾移植患者妊娠最常见的妊娠并发症是子痫前期。Objective To study the outcome of pregnance among women who received renal transplantation in our hospital. Methods The medical records of pregnant women who received renal transplantation between 2000 and 2007 were reviewed. The obstetrical data, transplant-related complications, plasma creatinine level, blood pressure at baseline, delivery and follow-up after delivery were recorded. Results 5 women had 6 pregnancies and 4 were expected pregnancy. 2 pregnancies were successful （one term and the other nearly term）. The new babies were normal whose birth weight were 3025g and 3070g respectively. There were 2 therapeutic abortions in the second trimester for severe pre-eclampsia. One patient of therapeutic abortions decreased the dosage of immunosuppressive drugs in pregnancy and two years later her renal function aggravated significantly. After another one year she received the second kidney transplantion. The other patient of therapeutic abortion stopped the drugs in pregnancy and suffered from severe pre-eclampsia, heart failure, severe anemia and renal function deterioration in the second trimester. Conclusions Renal transplantation is the best treatment for fertile women with end-stage renal disease who want to be pregnant. However, pregnancy is risky for the mother, fetus, newborn and allograft. Decreasing and stopping the use of immunosuppressive drugs are the causes of poor outcomes. The most frequent complication is pre-eclampsia.

关 键 词：肾移植 妊娠 结局 

分 类 号：R699.2[医药卫生—泌尿科学] R713.9[医药卫生—外科学]