妊娠合并神经精神性系统性红斑狼疮一例  

A Case of Pregnancy Complicated with Neuropsychiatric Systemic Lupus Erythematosus

作　　者：陈慧赟 韩冰[1] 陈洁[1] 张洁[1] 章鹤 张英辉[1] CHEN Hui-yun;HAN Bing;CHEN Jie;ZHANG Jie;ZHANG He;ZHANG Ying-hui(Department of Obstetrics and Gynecology,The First Afiliated Hospital of Soochow University,Suzhou 215006,Jiangsu Province,China)

机构地区：[1]苏州大学附属第一医院妇产科,215006

出　　处：《国际妇产科学杂志》2024年第6期629-632,共4页Journal of International Obstetrics and Gynecology

摘　　要：报告1例妊娠晚期无明显诱因于睡眠时癫痫样发作,发作时意识不清,数分钟后自行转醒,自觉头晕头痛,急诊收入院诊治的病例。该患者既往有系统性红斑狼疮、抗磷脂综合征、高血压、下肢深静脉血栓病史及不良孕产史(胎死宫内、自然流产),本次妊娠合并妊娠期糖尿病。追溯家族史,其母亲有癫痫发作病史。患者入院后生命体征平稳,无痫性发作,完善相关辅助检查,组织多学科会诊,考虑患者为神经精神性系统性红斑狼疮,予大剂量甲泼尼龙治疗、治疗剂量的低分子肝素抗凝、地塞米松促胎儿肺成熟,于孕33^(+3)周在全身麻醉下行剖宫产终止妊娠,手术顺利,娩出一女婴,体质量1 810 g,新生儿出生1 min、5 min Apgar评分分别为10分、10分,早产儿转新生儿科治疗,产妇术后7 d出院,4个月后至专科医院就诊,预后良好。The patient was a female of childbearing age.She had a seizure in late pregnancy during sleep without any obvious trigger and with unconscious during the seizure,awakening on her own after a few minutes,but felt dizzy and had a headache and was admited to the hospital as an emergency.This patient had a history of systemic lupus erythematosus,antiphospholipid syndrome,hypertension,deep vein thrombosis of the lower extremities,and disfavorable pregnancies(such as intrauterine fetal death,spontaneous abortion).Gestational diabetes mellitus was present in this pregnancy.Her mother has a history of epileptic seizures.The patient's vital signs were stable and she has not had a seizure since admission.We performed the relevant ancillary examinations and multi-disciplinary treatment.We considered the patient's diagnosis of neuropsychiatric systemic lupus erythematosus and treated her with high-dose methylprednisolone and therapeutic doses of low molecular heparin,and dexamethasone to promote fetal lung maturation.We performed a cesarean section under general anesthesia at 33^(+3) weeks of the patient's gestation and the operation was successful.She delivered a female infant weighing 1810 g and the infant's 1 min,5 min Apgar score were 10-10.The preterm baby was transferred to the neonatal unit for treatment,and the mother was discharged seven days after surgery and presented to the specialist four months later.The prognosis for both mother and daughter was favorable.

关 键 词：神经精神性系统性红斑狼疮 红斑狼疮 系统性 癫痫 妊娠 自身免疫疾病 甲泼尼龙 

分 类 号：R714.25[医药卫生—妇产科学]