翻譯：李樂謙1 餘欣玥1 梁晶晶2 黃啟濤3
（1. 南方醫科大學第一臨床醫學院；2. 南方醫科大學第二臨床醫學院；3. 南方醫科大學南方醫院婦產科）
審核：陳繼明
（南京醫科大學附屬常州第二人民醫院婦產科；南京醫科大學常州臨床醫學院婦產科學教研室）
ERS／TSANZ工作組聲明：患有呼吸道疾病女性生殖和妊娠管理(上)
背景
該聲明概述了有關治療呼吸道疾病婦女生殖和妊娠的文獻和專家意見。該聲明是歐洲呼吸學會(ERS)和澳大利亞和新西蘭胸科學會(TSANZ)為制定此類文件而開展的第一次合作。
該聲明涵蓋呼吸道疾病，即哮喘，囊性纖維化（CF）和非CF支氣管擴張。現在，患有這些疾病的許多婦女正處於生育年齡，其中一些在成年早期發展為中度至嚴重的肺功能損害。該聲明涵蓋了生育，懷孕期間的管理，藥物作用和分娩期間的問題。
該聲明總結了當前的知識，但未提出推薦。該聲明將不討論懷孕期間發生的生理變化，例如氣道生理，休息通氣和睡眠的變化，這些變化已在其他地方進行了總結[1]。該聲明將不涵蓋其他形式的肺部疾病，例如肺纖維化，肺動脈高壓，與胃食管反流相關的肺部疾病或尼古丁消耗問題。
工作組的考慮
請注意，摘要並非基於隨機對照試驗。
相容（可以使用）：一般而言，此選項被視為首選藥物，在懷孕和/或母乳餵養期間應耐受，因為在人類懷孕期間使用已有足夠的軼事證據，表明胚胎胎兒的風險非常低或沒有。
很可能安全：通常，在人類妊娠（或母乳餵養）期間的試驗經驗有限，但該藥物的特性和/或同類藥物表明其風險較低。
有可能安全：如果經過更好測試的治療方法失敗，則考慮將該藥物用於二線治療。儘管確切的風險尚不清楚，但直接的孕產婦收益被認為可能超過懷孕和/或母乳餵養期間的潛在風險。
母乳餵養：請注意，所有列出的內容均指按照標準推薦劑量和持續時間服用列出藥物的母親的足月，健康，完全由母乳餵養的嬰兒。
在所有情況下，臨床醫生都應比較每種藥物的益處和風險。
對於所有藥物表，Pre =先孕；T1，T2和T3指的是前期、中期和晚期妊娠。
藥物名稱由通用化合物名稱以及（TGA）[FDA]分類組成
總之，在孕期和哺乳期使用任何藥物都需要平衡母親接受治療與不接受治療的風險、母親疾病失控時胎兒的風險和新生兒接受治療的風險。在患有哮喘的婦女中，吸入藥物已使用多年而無任何有關胎兒不良反應的記錄。相反，對哮喘的治療不足導致母體缺氧嚴重惡化，對胎兒產生不良影響。
單克隆抗體不太可能大量穿過胎盤而對胎兒造成傷害，如果需要控制母親的哮喘，則應在懷孕期間繼續使用單克隆抗體。
對患有支氣管擴張和囊性纖維化的婦女，在整個妊娠期間，應用吸入性支氣管擴張劑、皮質類固醇抗生素和黏液溶解劑進行常規治療，以繼續保持母體的穩定性。與全身性抗生素相關的任何風險因藥物而異，選擇時應基於母親的臨床基礎，同時兼顧對胎兒的風險。
審校簡介
陳繼明
陳繼明，男，副主任醫師，醫學博士（在站博士後），碩士研究生導師。現任南京醫科大學常州臨床醫學院婦產科學教研室主任，南京醫科大學附屬常州第二人民醫院大婦科副主任兼婦科病區主任，南京醫科大學附屬常州第二人民醫院陽湖院區臨床第三黨支部書記。主要專業特長為婦科內分泌疾病及婦科良惡性腫瘤的微創治療，擅長經臍單孔腹腔鏡手術（TU-LESS）及經陰道自然通道單孔腹腔鏡手術（V-NOTES）。熟練掌握單孔腹腔鏡下婦科良惡性腫瘤手術及單孔腹腔鏡下深部子宮內膜異位症手術，並將5mm mini切口單孔腹腔鏡手術廣泛應用於婦科疾病的診治。單孔腹腔鏡技術曾獲市醫學新技術引進獎一等獎（2017），江蘇省醫學新技術引進獎二等獎（2019），院醫學新技術引進獎二等獎（2019），第六屆/第七屆中國婦產科網手術視頻大賽三等獎，第六屆/第七屆SESGE優秀手術視頻獎，第六屆婦科腫瘤長江論壇青年醫師優秀視頻二等獎，2018江蘇抗癌協會婦科腫瘤年會視頻比賽二等獎，第六屆珠江論壇手術視頻決賽優秀獎，第11屆子宮內膜異位手術大賽——江蘇區域賽冠軍，全國總決賽季軍等。
現任“中華預防醫學會生育力保存分會生殖內分泌生育保護學組委員”、“中國醫師協會婦產科分會婦科單孔腹腔鏡技術全國科研協作組成員”、“中國成人教育協會繼續醫學教育委員會腔鏡國際培訓中心常務委員”、 “中國性科學理事會專家委員會委員” 、“中國中藥協會女性生殖健康藥物研究專業委員會委員”、 “中國中藥協會真實世界研究專業委員會委員”、 “中國中醫藥研究促進會中西醫結合婦產與婦幼保健分會委員”、 “中國醫藥教育協會畢業後與繼續醫學教育指導委員會委員”、“中國研究型醫院學會婦科腫瘤專業委員會青年委員”、 “中國婦幼保健協會婦幼微創分會青年委員會全國青年委員”、 “中國老年醫學學會婦科分會青年委員會委員”、“中國婦幼保健協會婦幼微創分會腹腔鏡學組委員”、“中國婦幼保健協會婦科內分泌專業委員會青年科研學組秘書”、“中國婦幼保健協會婦科內分泌專業委員會婦科內分泌與腫瘤青年學組委員”、“中國婦幼保健協會婦科內分泌專業委員會健康扶貧工作學組委員”、 “中國醫療保健國際交流促進會婦產科分會婦產科創新技術與臨床轉化學組委員”、“中國整形美容協會女性生殖整復分會生殖物理整復專業學組成員”、“江蘇省醫學會婦科腫瘤學分會委員”、“江蘇省醫師協會婦產科醫師分會委員”、“江蘇省老年醫學學會婦科分會常務委員”、“江蘇省醫師協會微無創醫學專業委員會婦科學組委員”、“江蘇省預防醫學會婦女保健專業委員會女性盆底學組成員”、“江蘇省預防醫學會婦女保健專業委員會婦科內分泌學組成員”、“常州市醫學會婦產科分會第五屆委員會委員兼秘書”、“常州市醫師協會婦產科醫師分會第二屆委員會委員兼秘書”、“同心.共鑄中國心”婦產科專家委員會常州分會副主任委員、“美國婦科腹腔鏡醫師協會（AAGL）會員”。
獲評"江蘇省333人才工程第三層次培養對象"、“江蘇省衛生拔尖人才”、“常州青年醫學創新人才工程培養對象”、“2018常州市引進優秀醫學博士”、“2019《健康報》社首批青年醫生全明星成長計劃”、“院十佳青年醫務工作者”、“院十佳黨員創新人才”、“院十佳患者信賴的醫務工作者”、“常州市醫學會先進個人”、“杏霖婦科內分泌研究院優秀科普講者”等。
現為《中國計劃生育與婦產科》、《國際婦產科前沿》、《現代藥物與臨床》等雜誌編委；《藥物評價研究》、《實用婦科內分泌》等雜誌中青年編委、《Life Research》editor；《World Journal of Gynecology & Women’s Health》editor；《中國腫瘤外科》、《中國性科學》、《石河子大學學報（自然科學版）》、《重慶醫學》、《安徽醫藥》等雜誌特邀審稿專家。目前發表各類論文120餘篇，其中SCI論文10餘篇，教學論文10餘篇。參譯婦科專業書籍1部，副主編書籍1部，參編書籍2部。主持各類科研項目8項，曾獲市醫學新技術引進獎一等獎1項，江蘇省醫學新技術引進獎二等獎1項，院醫學新技術二等獎1項，在全國各類病例演講/科普演講/論文演講/手術視頻演講等比賽中榮獲冠軍/亞軍/季軍及優秀獎等共計30餘項/次。
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