三例妊娠合并2019冠状病毒病(COVID-19)患者诊治分析  

Pregnant women complicated with COVID-19:a clinical analysis of 3 cases

作　　者：陈旭 李央[1] 王金希 蔡洪流[2] 曹红翠[3] 盛吉芳[3] CHEN Xu;LI Yang;WANG Jinxi;CAI Hongliu;CAO Hongcui;SHENG Jifang(Department of Obstetrics and Gynecology,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Critical Care Medicine,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Infectious Diseases,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院妇产科,浙江杭州310003 [2]浙江大学医学院附属第一医院重症医学科,浙江杭州310003 [3]浙江大学医学院附属第一医院感染科,浙江杭州310003

出　　处：《浙江大学学报（医学版）》2020年第2期240-244,共5页Journal of Zhejiang University(Medical Sciences)

摘　　要：目的:研究妊娠合并2019冠状病毒病(COVID-19)患者的临床特点及妊娠结局。方法:对浙江大学医学院附属第一医院2020年1月19日至2月10日收治的3例妊娠合并COVID-19患者的临床表现、辅助检查、治疗经过、妊娠结局进行回顾性分析。结果:3例患者早孕(例1)、中孕(例2)、晚孕(例3)各1例,例1和例3为COVID-19普通型,例2为COVID-19重型;以咳嗽、发热、乏力、肺部影像学改变为主要表现,例1、例3实验室检查提示白细胞计数、淋巴细胞百分比等无明显变化,炎症指标如C反应蛋白、红细胞沉降率、IL-6、IL-10等轻度升高,例2淋巴细胞计数及淋巴细胞百分比明显降低,炎症因子水平明显升高。3例患者经过抗病毒、止咳、吸氧等综合治疗,其中例2使用糖皮质激素和丙种球蛋白调节免疫治疗,例3使用糖皮质激素,均符合出院标准。例1出院后选择终止妊娠;例2无产科并发症选择继续妊娠;例3因胎心监护异常行剖宫产终止妊娠,母胎情况良好。结论:妊娠合并COVID-19患者经积极治疗可以痊愈,母胎结局良好,但对子代的影响仍需进一步研究。Objective:To analyze the clinical characteristics and pregnancy outcomes of pregnant women complicated with coronavirus disease 2019(COVID-19).Methods:The clinical data of 3 pregnant women with COVID-19 admitted to the First Affiliated Hospital of Zhejiang University School of Medicine from January 19 to February 10,2020 were retrospectively analyzed.Results:There was one case in the first-trimester pregnancy(case 1),one in the second-trimester pregnancy(case 2)and one in third-trimester pregnancy(case 3).Cough,fever,fatigue,lung imaging changes were the main manifestations.The white cell count,lymphocyte percentage had no significantly changes in case 1 and case 3,while the levels of C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),IL-6 and IL-10 elevated.The lymphocyte count and lymphocyte percentage decreased and the inflammatory indicators significantly increased in case 2.All patients were treated with antiviral,antitussive,oxygen inhalation;case 3 received glucocorticoids,case 2 with severe illness received glucocorticoids and additionally gamma globulin.All three cases were cured and discharged.Case 1 with early pregnancy chose to terminate pregnancy after discharge;case 2 chose to continue pregnancy without obstetric complications;and case 3 had cesarean section delivery due to abnormal fetal heart monitoring.Conclusion:The report shows that COVID-19 in pregnancy women could be cured with active treatment,and the maternal and fetal outcomes can be satisfactory.

关 键 词：2019冠状病毒病 严重急性呼吸综合征冠状病毒2 新型冠状病毒肺炎 妊娠 妊娠结局 

分 类 号：R714.251[医药卫生—妇产科学]