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目的提高临床医师对化疗药物在妊娠期应用安全性的认识,及时治疗母体白血病,切实改善母婴预后。方法回顾性分析山西医科大学第二医院1例妊娠合并急性粒单核细胞白血病患者的诊治过程及其预后,并通过检索英文文献数据库对相关文献进行复习。结果本例患者29岁,确诊急性粒单核细胞白血病1个月后妊娠,妊娠期给予输注浓缩红细胞、预防感染等对症支持治疗,未行化疗,妊娠40+4周予欣普贝生促宫颈成熟,分娩1活男婴。产后4个月内母体接受输血治疗7次,坚持母乳喂养仍拒绝化疗。分析原因与临床医师及患者对化疗药物在妊娠期应用的安全性认识不够有关。文献显示分娩前进行诱导治疗比分娩后进行诱导治疗的患者获得更长时间的生存期;化疗药物发生致畸的高风险孕周是5~10周,直至孕13周胎儿器官已完全形成后致畸风险减少,孕中晚期行化疗相对安全。结论在临床中应正确认识化疗药物对妊娠期白血病患者母婴的作用,由临床多科室合作诊疗,及时治疗母体白血病,选择最佳的治疗时机及治疗方案。
Objective To improve clinicians’ understanding of the safety of chemotherapy drugs in pregnancy and timely treatment of maternal leukemia and effectively improve the prognosis of maternal and infant. Methods The diagnosis and treatment of pregnancy complicated with acute myelomonocytic leukemia in the second hospital of Shanxi Medical University and its prognosis were retrospectively analyzed. The related literatures were reviewed by searching the English literature database. Results The patient was 29 years old, diagnosed with acute myelomonocytic leukemia one month after pregnancy, during pregnancy given infusion of packed red blood cells, prophylaxis and other symptomatic and supportive treatment, without chemotherapy, pregnancy 40 + , Giving birth to a living baby boy. Within 4 months after delivery, the mother received blood transfusion 7 times, insisting that breastfeeding still refused chemotherapy. Analysis of the reasons and clinicians and patients on the safety of chemotherapy drugs in pregnancy is not enough understanding. The literature shows that induction therapy before delivery gives longer survival than induction therapy after childbirth; teratogenic high-risk gestational weeks for chemotherapy drugs are 5 to 10 weeks until fetal organs are fully formed after 13 weeks of gestation Teratogenic risk reduction, the second trimester chemotherapy is relatively safe. Conclusions In clinic, we should correctly understand the effect of chemotherapeutic drugs on mother-infant in pregnant women with leukemia. Clinical multi-departmental cooperation diagnosis and treatment, timely treatment of maternal leukemia, choose the best timing and treatment options.