妊娠合并哮喘
2010/01/07
哮喘是妊娠期妇女重要的合并症。最近的调查数据显示，近8%的妊娠期妇女合并有哮喘。相对于无哮喘病史者，有哮喘的妊娠期妇女更易出现并发症，包括先兆子痫、早产、低出生体重儿或胎儿宫内生长受限、婴儿先天性畸形和围产期死亡等等。而哮喘患者在怀孕期间出现的哮喘临床症状可能较前改善、恶化或保持不变，但其机制至今仍不明确。
由于大多数患者都有明确的哮喘病史，因此诊断妊娠合并哮喘并不难。目前认为，应用常用的控制哮喘的药物给孕妇带来的风险绝对低于由于哮喘未控制而出现的风险。因此，建议已得到良好控制的哮喘孕妇继续维持原药物治疗。β－激动剂吸入剂和布地奈德是最被广泛研究的药物。作者认为，较其他吸入糖皮质激素，吸入布地奈德（180μg，Bid）最为安全。已有资料显示色甘酸钠和茶碱在孕妇哮喘中应用是安全的。而关于白三烯受体拮抗剂在孕妇哮喘中应用的安全性，报道则十分有限。
孕妇哮喘急性发作时，应予β -受体激动吸入剂、抗胆碱药物吸入剂及全身皮质类固醇进行治疗。其动脉血氧饱和度应至少维持在95％以上，以确保母体和胎儿有足够的氧供应。已控制哮喘孕妇需每月随访1次，而未控制患者应每1～2周随访1次，直到控制。
最新英国妊娠合并哮喘诊治指南是在2004年出版。而由美国妇产科学院制定的指南在2008年得到更新。
（张清玲 深圳市第二人民医院呼吸内科 518039 摘译）
(N Engl J Med , 2009 April;360:1862-1869.)
Michael Schatz, M.D., and Mitchell P. Dombrowski, M.D. Asthma in Pregnancy.
N Engl J Med 2009 April;360:1862-9.
N Engl J Med 2009 April;360:1862-9.
ABSTRACT
Asthma is probably the most common serious medical problem that occurs during pregnancy. Approximately 8% of pregnant women reported current asthma in recent national surveys. Women with asthma have been reported to have higher risks of several complications of pregnancy, including preeclampsia, preterm birth, infants with low birth weight or intrauterine growth restriction, infants with congenital malformations and perinatal death than women without a history of asthma. In addition, the severity of asthma may improve, worsen, or remain unchanged during pregnancy and the mechanisms remain undefined.
The diagnosis of asthma is usually straightforward, since most patients have a known history of asthma antedating pregnancy. The risks associated with asthma medications in current use are considered to be definitely lower than the risks associated with uncontrolled asthma. It is appropriate for pregnant patients with well-controlled asthma to continue taking their medications. The inhaled β-agonist, albuterol and budesonide is the most extensively studied drugs. The author recommends to choose inhaled budessonide(180μg per puff, two puffs twice a day) over other inhaled corticosteroids. Reassuring data on the use of cromolyn and theophylline in pregnant women have been published. Data on the use of leukotriene-receptor antagonists during pregnancy are more limited.
An asthma exacerbation in a pregnant patient should be managed with inhaled β-agonists, inhaled anticholinergic drugs, and systemic corticosteroids. Maintenance of an arterial oxygen saturation of at least 95% is recommended to ensure sufficient oxygenation in both the mother and the fetus. Monthly visits to assess asthma control are recommended for women who require controller therapy during pregnancy. Patients with very poorly controlled asthma should be seen every 1 to 2 weeks until control is achieved.
National guidelines for the management of asthma during pregnancy were most recently updated in 2004 and the one published by American College of Obstetricians and Gynecologists were updated in 2008.
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检测患者哮喘知识：结果评价的系统综述
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