脊髓损伤女性产前、产时、产后保健管理指南

doi:10.3969/j.issn.1006-9771.2020.00.009

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (11): 1256-1262.doi: 10.3969/j.issn.1006-9771.2020.00.009

脊髓损伤女性产前、产时、产后保健管理指南

Sue Bertschy¹,Markus Schmidt²,Kai Fiebag³,Ute Lange⁴,Simone Kues⁵,Ines Kurze⁶,刘根林^1,²,周红俊^1,²(),李建军³,陈素文⁴,郑樱^1,²,郝春霞^1,²,张缨^1,²,卫波^1,²,王一吉^1,²,康海琼^1,²,逯晓蕾^1,²,袁媛^1,²,蒙倩茹^1,²,译

1.Swiss Paraplegic Research (SPF), Nottwil, Switzerland
2.Sana Clinics Duisburg, Duisburg, Germany
3.Department of Neuro-urology, BG Clinic Hamburg, Hamburg, Germany
4.Department of Applied Heath Sciences, University of Applied Sciences, Bochum, Germany
5.Department of Psychology, BG Clinic Hamburg, Hamburg, Germany
6.Department for Paraplegia and Neuro-urology, Centre of Spinal Cord Injuries and Diseases, Bad Berka, Germany
译者单位:1.首都医科大学康复医学院,北京市 100068
2.中国康复研究中心北京博爱医院脊髓损伤康复科,北京市 100068
3.中国康复科学所,北京市 100068
4.首都医科大学附属北京妇产医院,北京市 100026

收稿日期:2020-07-08 修回日期:2020-07-10 出版日期:2020-07-22 发布日期:2020-11-24
通讯作者: 周红俊 E-mail:zh87569303@qq.com
作者简介:刘根林(1965-),男,汉族,浙江义乌市人,博士,主任医师,主要研究方向：脊髓损伤康复。

Guideline for the Management of Pre-, Intra-, and Postpartum Care of Women with A Spinal Cord Injury

Sue Bertschy¹,Markus Schmidt²,Kai Fiebag³,Ute Lange⁴,Simone Kues⁵,Ines Kurze⁶,LIU Gen-lin^1,²,ZHOU Hong-jun^1,²(),LI Jian-jun³,CHEN Su-wen⁴,ZHENG Ying^1,²,HAO Chun-xia^1,²,ZHANG Ying^1,²,WEI Bo^1,²,WANG Yi-ji^1,²,KANG Hai-qiong^1,²,LU Xiao-lei^1,²,YUAN Yuan^1,²,MENG Qian-ru^1,², trans.

1. Swiss Paraplegic Research (SPF), Nottwil, Switzerland
2. Sana Clinics Duisburg, Duisburg, Germany
3. Department of Neuro-urology, BG Clinic Hamburg, Hamburg, Germany
4. Department of Applied Heath Sciences, University of Applied Sciences, Bochum, Germany
5. Department of Psychology, BG Clinic Hamburg, Hamburg, Germany
6. Department for Paraplegia and Neuro-urology, Centre of Spinal Cord Injuries and Diseases, Bad Berka, Germany
Translator Affiliation:1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2. Department of Spinal Cord Injury Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Centre, Beijing 100068, China
3. China Rehabilitation Science Institute, Beijing 100068, China
4. Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China

Received:2020-07-08 Revised:2020-07-10 Published:2020-07-22 Online:2020-11-24
Contact: ZHOU Hong-jun E-mail:zh87569303@qq.com

摘要/Abstract

摘要：

德国医学科学协会发布的女性脊髓损伤患者产前、产时、产后管理指南涉及从备孕到不同孕期及分娩等一系列问题的管理。鉴于目前针对这一复杂问题还缺少公众可及并循证的管理办法,这一新指南致力于建立脊髓损伤女性的妇科、产科和孕产期保健管理标准。本指南的目标是为脊髓损伤女性产前、产时、产后的咨询和保健提供实用指导,填补该领域医疗服务的缺口,促进相关学科临床工作者的协作,激发深入的专业研究。

关键词: 脊髓损伤, 女性, 怀孕, 分娩, 指南

Abstract:

The German Association of the Scientific Medical Societies guideline for pregnancy, childbirth, and puerperium in women with a spinal cord injury (SCI) addresses a range of topics from the desire to have a child to different stages of pregnancy and birth. Given that a generally accessible and evidence-based presentation of this complex issue does not yet exist, this new guideline contributes to the standardization of gynecological, obstetric, and maternal care of women with SCI. This guideline aims to provide practice-oriented support for the care and counseling of women in the pre-, intra-, and postpartum periods; to close identified gaps in medical care; foster collaboration among clinicians of relevant disciplines; and inspire research.

Key words: spinal cord injury, women, pregnancy, birth, guideline

中图分类号:

R651.2

Sue Bertschy,Markus Schmidt,Kai Fiebag,Ute Lange,Simone Kues,Ines Kurze,刘根林,周红俊,李建军,陈素文,郑樱,郝春霞,张缨,卫波,王一吉,康海琼,逯晓蕾,袁媛,蒙倩茹,译. 脊髓损伤女性产前、产时、产后保健管理指南[J]. 《中国康复理论与实践》, 2020, 26(11): 1256-1262.

Sue Bertschy,Markus Schmidt,Kai Fiebag,Ute Lange,Simone Kues,Ines Kurze,LIU Gen-lin,ZHOU Hong-jun,LI Jian-jun,CHEN Su-wen,ZHENG Ying,HAO Chun-xia,ZHANG Ying,WEI Bo,WANG Yi-ji,KANG Hai-qiong,LU Xiao-lei,YUAN Yuan,MENG Qian-ru, trans.. Guideline for the Management of Pre-, Intra-, and Postpartum Care of Women with A Spinal Cord Injury[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(11): 1256-1262.

图/表 3

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参考文献 50

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项目	1~3个月	4~6个月	7~9个月	处理方法
自主神经	AD	AD	AD	抬高上身;消除诱发因素;使用降压药(围产期注意观察动脉导管未闭)
膀胱	泌尿系感染;尿失禁	泌尿系感染;尿失禁;肾盂肾炎;尿路结石	泌尿系感染;尿失禁;肾盂肾炎;尿路结石	肾盂肾炎治愈后泌尿系感染预防;增加导尿次数;短期留置尿管
直肠	便秘	便秘	便秘;直肠受压影响排便;排便体位受限	调整饮食和饮水习惯;根据情况使用不同药物;考虑使用辅助手段
皮肤		压疮风险增加	压疮风险增加	增加减压次数;增加皮肤检查次数;减少转移;使用坐垫、床垫、浴凳等
体质量		体质量增加	体质量增加	健康饮食
移动			移动减少和身体力学变化;疲劳增加;日常生活依赖性增加	改变日常用轮椅的轴心和前挡板的位置;短期租用电动轮椅;模拟练习大肚子移动;日常生活增加时间
痉挛			痉挛加重	使用物理疗法;避免诱发痉挛
呼吸功能			呼吸和潮气量下降;有效咳嗽能力下降	呼吸训练;加压或持续正压通气;口服化痰药

项目	AD	先兆子痫
损伤水平	常在T₆以上	与损伤水平无关
血压	突然明显上升	缓慢上升
心率	多数心动过缓,早期心动过速	多数正常
蛋白尿	无	有(> 300 mg/24 h)
临床表现	面部潮红、出汗、鸡皮疙瘩、头部跳痛、反射增强	水肿、持续头痛、视力模糊、上腹部疼痛、反射增强
血清学特点	不典型	可能发生诸如血小板减少综合征(尿酸升高、转氨酶升高、血小板降低、结合珠蛋白降低)

分类	药物	哺乳期
抗痉挛药	力奥来素	不能用
	地西泮	相对禁忌,短期使用
抗胆碱药	曲司氯胺、丙哌维林	严格控制适应证
	奥昔布宁	不能用
	肉毒素
止痛药	对乙酰氨基酚	首选
	布洛芬	替代首选
	安乃近	避免用,必要时限用1次
抗癫痫药	加巴喷丁	可用单一疗程
	普瑞巴林	低剂量可用单一疗程

脊髓损伤女性产前、产时、产后保健管理指南

Guideline for the Management of Pre-, Intra-, and Postpartum Care of Women with A Spinal Cord Injury

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