肾移植受者术后妊娠及母婴预后：单中心的回顾性总结

发布时间：2018-01-14 03:28

本文关键词：肾移植受者术后妊娠及母婴预后：单中心的回顾性总结　出处：《浙江大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：对浙江大学附属第一医院所有肾移植术后成功分娩的女性受者予以总结,探讨肾移植术后妊娠过程对母体、胎儿及移植物本身的影响。方法：回顾性分析浙江大学附属第一医院肾脏病中心自1992年4月至今资料,共有12名女性肾移植受者在术后成功妊娠并分娩,并各自生育子女1名。在肾移植手术医院及生育医院收集受者及其子女的资料,包括供肾类型,受体手术时年龄、移植妊娠间期、妊娠期间免疫抑制剂的应用、孕周、妊娠期间母体并发症、分娩及麻醉方式、胎儿出生情况以及移植物预后等。结果：12例受体里有10例(83.3%)接受了尸肾移植,有2例(16.7%)接受了活体肾移植,移植手术时的年龄为(22.8±4.3)岁,移植妊娠间期为(5.5±2.9)年,妊娠期间有5例(41.7%)使用了强的松、硫唑嘌呤和环孢素A抗排异,有6例(50.0%)使用了强的松、硫唑嘌呤和他克莫司联用抗排异,有1例仅使用强的松和硫唑嘌呤抗排斥。所有的胎儿均通过连续硬膜外麻醉下剖宫产分娩,有1例因妊娠期间移植肾失功于28周进行剖腹产,有6例(50%)为早产,5例足月产。12名子女男女比例为6：6,出生时体重为(2734±364)g,身高(48.1±3.1)cm,双顶径大小为(8.9±0.5)cm, Apgar评分为(9.9±0.2),出生时未发现明显畸形,均进行人工喂养,目前年龄最大者为18岁,最小为3天。12例受者在妊娠期间并发子痫前期(包括高血压)6例次,蛋白尿5例次,贫血4例次,移植肾功能不全3例次,妊娠期糖尿病2例次。结论：肾移植受体在术后可以进行妊娠,但有一定的风险,可能会影响移植物的功能。整个妊娠过程均需移植科医师与产科医师的密切配合随访,通过选择最佳怀孕时机、严密监测孕期各项化验指标,最终能提高肾移植术后受体妊娠的成功率,为育龄期尿毒症女患者带来家庭的福音。
[Abstract]:Objective: to summarize all the female recipients of successful delivery after renal transplantation in the first affiliated Hospital of Zhejiang University, and to explore the effect of pregnancy process on maternal, fetal and graft itself. Methods: the data of renal disease center of the first affiliated Hospital of Zhejiang University since April 1992 were retrospectively analyzed. There were 12 female renal transplant recipients who were pregnant and delivered successfully after operation. The data of recipients and their children were collected in the renal transplantation hospital and fertility hospital, including the type of donor kidney, the age of recipient at the time of operation, the period of transplantation pregnancy, the application of immunosuppressant during pregnancy. Gestational weeks, maternal complications during pregnancy, delivery and anaesthesia, fetal birth and graft prognosis. Results of the 12 recipients, 10 received cadaveric kidney transplantation and 2 received live kidney transplantation. The age of transplantation was 22. 8 卤4. 3 years. During pregnancy, prednisone, azathioprine and cyclosporine A were used in 5 (5.5 卤2.9) years, and prednisone, azathioprine and cyclosporine A were used in 6 (50.0) years. Azathioprine and tacrolimus were used in combination with anti-rejection. In one case only prednisone and azathioprine were used against rejection. All fetuses were delivered by cesarean section under continuous epidural anesthesia. One case underwent caesarean section at 28 weeks due to kidney transplantation during pregnancy, and 6 cases underwent cesarean section. The ratio of male to female was 6: 6 in 5 cases of term labor and 5 cases of term delivery. The birth weight was 2734 卤364g, the height was 48.1 卤3.1 cm, the biparietal diameter was 8.9 卤0.5 cm, and the Apgar score was 9.9 卤0.2). No obvious malformation was found at birth. The oldest was 18 years old and the youngest was 3 days. 12 recipients were complicated with preeclampsia during pregnancy (including 6 cases of hypertension). Proteinuria 5 times, anemia 4 times, renal allograft insufficiency 3 times, gestational diabetes 2 times. Conclusion: renal transplant recipients can be pregnant after operation, but there are certain risks, which may affect the function of grafts. The whole process of pregnancy should be closely followed up by transplant doctors and obstetricians. By selecting the best time of pregnancy and closely monitoring the laboratory indexes during pregnancy, the success rate of recipient pregnancy after renal transplantation can be improved, and the family gospel will be brought to the female patients with uremia at childbearing age.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2

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