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目的探讨妊娠合并脊髓损伤的孕期康复及处理。方法总结在我院检查并分娩的4例妊娠合并脊髓损伤者的临床资料,对所有患者治疗前进行Barthel指数评分、汉密尔顿焦虑量表评分、汉密尔顿抑郁量表评分,结合文献讨论其孕期康复、分娩及产后管理。结果 4例妊娠合并脊髓损伤病例,均为初次妊娠,年龄27~33岁,分娩孕周为35+周~38周,脊髓损伤平段T8-T10,4例孕期均有尿失禁、便秘,2例孕期轻中度贫血,1例合并胎儿生长受限,1例合并妊娠期糖尿病。3例胎膜早破,2例早产。3例全麻下行子宫下段剖宫产术,1例产钳助产分娩。4例新生儿1min Apgar评分均为10分,体重2 350~3 350 g。经过孕期系统康复训练Barthel指数、汉密尔顿焦虑量表评分、汉密尔顿抑郁量表评分的各项指标有明显改善。结论妊娠合并脊髓损伤患者孕期应坚持心理疏导及康复训练,在多学科团队,特别是产科医生与康复医学科、麻醉科医师的密切协作下,通常有良好的妊娠结局;但要警惕早产、自主神经反射异常的风险。
Objective To investigate the pregnancy rehabilitation and treatment of pregnancy complicated with spinal cord injury. Methods The clinical data of 4 pregnant women with spinal cord injury who were examined and delivered in our hospital were summarized. Barthel index score, Hamilton Anxiety Scale score and Hamilton Depression Scale score before treatment were all found in all patients. And postnatal management. Results Four cases of pregnancy with spinal cord injury were all primary pregnancies, ranging in age from 27 to 33 years. The gestational weeks of delivery were 35+ weeks to 38 weeks. T8-T10 in the spinal cord transection, 4 cases of urinary incontinence, constipation, 2 A mild to moderate anemia during pregnancy, 1 case of fetal growth restriction, 1 case of gestational diabetes mellitus. 3 cases of premature rupture of membranes, 2 cases of premature delivery. 3 cases of lower uterine cesarean section under general anesthesia, 1 forceps midwifery delivery. 4 neonates 1min Apgar score was 10 points, weight 2 350 ~ 3 350 g. Barthel index, Hamilton Anxiety Scale score and Hamilton Depression Scale score improved significantly during pregnancy. Conclusion Patients with pregnancy-associated spinal cord injury should adhere to psychological counseling and rehabilitation during pregnancy. Patients with pregnancy-associated spinal cord injury should always have good pregnancy outcomes in close collaboration with the multidisciplinary teams, especially the obstetricians and rehabilitation medicine and anesthesiologists. However, we must guard against premature delivery and autonomy Risk of neurological abnormalities.