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母婴阻断创造新奇迹 艾滋病人产下一健康生命
优讯-中国网 china.com.cn/info 时间： 2011-01-02 责任编辑: 叶子
12月1日，南宁市第四人民医院里，随着一声新生儿的啼哭，医生、护士、产妇和初生儿的父亲一起欢呼。原来，又一名携带艾滋病病毒的产妇在这里顺利产下一名男婴。
母婴传播是艾滋病传播的三种途径之一。近几年，我区的孕产妇感染数正以每年100多例的速度逐年上升。数据显示，在不进行干预的情况下，艾滋病病毒母婴传播发生率通常在15％~50％之间波动。而规范有效的综合干预，可使母婴传播率降至1%以下。
新生儿喜获“新生”
阿凤（化名）住进南宁市第四人民医院的时候已经怀孕。她告诉医生自己染上了艾滋病，希望能生下一个健康的孩子，延续她的生命。
“目前认为艾滋病母婴传播是可以通过综合干预阻断的。”南宁市第四人民医院妇产科主任庞俊说，联合高效的抗病毒治疗、安全分娩与人工喂养，母婴传播率可下降至1%以下。因此，携带艾滋病毒的孕妇生出没有感染艾滋病病毒的宝宝是可能的。
经过分析和严格的检查，阿凤决定接受抗病毒药物治疗，生下孩子。
“阿凤很配合治疗，为了孩子，医生让她做什么都行，也从不喊疼。”庞俊说，一切顺利，阿凤生下一个男孩。两年后，在送孩子上幼儿园的前一周，阿凤又带儿子到医院做血液检查，结果显示孩子HIV阴性。阿凤激动得当场给庞俊跪下，连呼：“救命大恩人！”
为了孩子选择坚强
对于HIV阳性的孕妇来说，最安全的方法是终止妊娠。但是，她们是活生生的人，有对孩子的渴望，也有按照自己意愿生活的权利。
几年前，一名孕妇在做围产保健时，查出HIV阳性。庞俊告诉她最好的办法就是终止妊娠。那名孕妇当即哇哇地哭了，歇斯底里地喊着：“我要孩子！”她最终决定在医生们的帮助下做母婴阻断。
“在所有艾滋病人里，孕妇是最可怜的。”庞俊说，怀上孩子本来是喜事，而对这些孕妇来说，却变成了悲哀之事。孕妇的心理本来就脆弱，HIV更让她们不堪一击。一些孕产妇因为自己染上艾滋病，不相信能生下一个健康宝宝，住院、出院、自杀；再住院、再出院、再自杀。医生们要拿出最大的热情和耐心，给她们做检测，制订合适的治疗方案，讲清母婴阻断的成功比例，告知其间身体可能会遭受的痛苦。想生孩子的愿望大于一切，妈妈们最终选择坚强。治疗时，她们的依从性非常好。
保护孩子免受打扰
记者试图采访阿凤，但所有的努力几乎全都落空。庞俊介绍，感染、携带艾滋病病毒的妈妈们是一个很特殊的群体。得知孩子没有携带艾滋病病毒后，她们像老母鸡护小鸡那样千方百计保护自己的孩子，想给孩子一个正常人的生活，不希望外人打扰。
曾有一个患艾滋病的妈妈，在孩子生下3个月时，医生们与她联系，希望她带孩子到医院抽血做检查。可她不愿去医院，怕碰到熟人。“那么，我们到你家里？”庞俊问。她也不同意，因为她的父母还不知道这事。怎么办？找个茶馆？可要在茶馆里给孩子抽血，也不合适啊。最后，医生们乘救护车到这个妈妈指定的地点。车刚停，还没看清她从哪里钻出来，她已抱着孩子冲到车上。“我们就像地下工作者一样。”庞俊说。
母婴阻断在艰难中前行
“目前，很多地区妇女孕期艾滋病病毒检测时间过晚，医生不能尽早获得孕产妇艾滋病感染状况，因而不能及时让感染了艾滋病病毒的妇女服用抗病毒药物或孕产妇用药不够规范，以致影响了艾滋病母婴传播干预措施的效果。但是，目前看来，我院收治的200多例艾滋病孕产妇生下的婴儿体检HIV都呈阴性，也就是说，母婴阻断暂时的成功比例是100%。”庞俊特别强调了“暂时”。“因为这些妈妈的孩子出生后要不没有感染HIV病毒，要不就是已感染，即便进行了规范有效的综合干预，患艾滋病的孕妇仍有生出不健康宝宝的风险。”
宫内感染、产时感染、母乳喂养是艾滋病母婴传播的3个关键环节。因此，预防感染了艾滋病病毒的妈妈将病毒传染给胎儿，避免分娩过程中新生儿感染艾滋病病毒，避免感染了艾滋病病毒的妈妈喂母乳导致婴儿染上艾滋病，成为阻断艾滋病母婴传播的关键。由于母婴感染最易发生在分娩期间，越接近分娩，危险性越大。如果能用抗病毒药物将母体的HIV病毒降低，孩子的感染几率就会降低，早发现、早治疗会有很好的阻断效果。然而，很多孕妇直到分娩前才被检出HIV阳性，失去了孕期抗病毒治疗的时机。
据介绍，从我区各地转入南宁市第四人民医院的艾滋病孕妇中，超过40%在孕晚期甚至产时才发现感染了艾滋病毒。这让艾滋病母婴阻断面对这么一个局面：我区至少有四成艾滋病孕妇丧失了规范抗病毒治疗的可能性。为此，庞俊呼吁：已感染艾滋病的孕妇如果想顺利分娩孩子，应该尽早主动到医院实行母婴阻断。她建议未婚青年男女重视婚检，重视艾滋病检查。庞俊说：“我们所说的‘健康宝宝’只说明孩子没有感染艾滋病毒，其他身体机能是否健康、孩子身体发育是否正常等，还要靠孕产妇自己及其家人对孩子进行积极监控和检查并治疗。”
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| 图示∶2010年12月即将出版的《中国特色医疗金鉴》登载的刘君主任及其机构 |
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PMTCT create new miracle birth to the healthy life of people with AIDS
Excellent News - China Network china.com.cn / info Date: 2011-01-02 Editor: leaves
December 1, Fourth People's Hospital in Nanning, with a loud cry of newborns, doctors, nurses, maternal and newborn child's father with joy. The original, but also one of the mothers with HIV gave birth to a baby boy here.
Mother to child transmission is one of three ways of HIV transmission. In recent years, our region the number of maternal infection at an annual rate of more than 100 cases increased year by year. Data show that in the case of non-intervention, the incidence of mother to child transmission of HIV is usually between 15% and 50% of the fluctuations. The standardized and effective integrated intervention, mother to child transmission rate could fall to 1% or less.
Newborn Receives "new"
Ah Feng (a pseudonym) was admitted to the Fourth People's Hospital of Nanning City, the time was pregnant. She told doctors he was infected with HIV, hoping to give birth to a healthy child, continuing her life.
"The current view of MTCT of HIV can be blocked by comprehensive intervention." Obstetrics and Gynecology Fourth People's Hospital of Nanning, director Pang Chun, said the joint effective antiretroviral therapy, safe delivery and artificial feeding, mother to child transmission rate can be reduced to 1%. Therefore, pregnant women with HIV give birth to the baby is not infected with HIV is possible.
After analysis and rigorous examination, Ah Feng decided to accept the antiviral therapy, having children.
"Ah Feng is with the treatment, for children, the doctor let her do anything, and never sore and." Pang Chun said that all goes well, A Fengsheng the next boy. Two years later, to send their children to kindergarten in the week before, Ah Feng and took his son to the hospital for blood test results showed that HIV-negative children. Ah Feng Pang Chun moved to the spot to kneel, Lianhu: "Help benefactor!"
The children decide to be strong
For HIV-positive pregnant women, the most secure method is to terminate the pregnancy. However, they are real people, with the desire for children, but also the right to live according to their own wishes.
A few years ago, when a pregnant woman doing Perinatal Care, found HIV positive. Pang Chun told her that the best way is to terminate the pregnancy. Wa Wade that pregnant women immediately cried, cried out hysterically: "I want kids!" She finally decided to help doctors make PMTCT.
"In all people with AIDS, the women are the most miserable." Pang Chun said the child was originally conceived happy event, and for these women, however, it became a matter of sorrow. The already fragile psychology of pregnant women, HIV Gengrang them vulnerable. Some pregnant women infected with AIDS because they do not believe that we can give birth to a healthy baby, hospital, hospital, suicide; another hospital, then discharged, and then committed suicide. Doctors to come up with the greatest enthusiasm and patience, to give them to do testing, the formulation of appropriate treatment, the proportion of clarifying the success of PMTCT, during which the body may be subjected to this pain. The desire to have children is greater than all, mothers who chose strong. Treatment, their compliance is very good.
Protection of children from disturbing
Ah Feng reporters tried to interview, but almost all of the efforts all in vain. Pang Chun introduction, infection, mothers with HIV is a very special group. That children do not carry AIDS virus, they are like a mother hen chicks that every possible care to protect their children, want to give children a normal life, do not want to disturb outsiders.
Had a mother with AIDS, the child gave birth to 3 months, contact with her doctors, the hospital wanted her kids to blood tests. But she do not want to go to the hospital, afraid met acquaintances. "So, we went to your house?" Pang Chun asked. She did not agree, because her parents did not know this. How to do? Find a tea house? You had better blood in the teahouse to the children, but also inappropriate ah. Finally, the doctors designated by ambulance to the location of this mother. Car just stopped, not drilled out to see her where she had been holding the child rushed to the car. "We just like the underground workers." Pang Chun said.
PMTCT during tough times ahead
"At present, many parts of the HIV testing during pregnancy too late, the doctor can not be obtained as soon as possible HIV infection in pregnant women, and therefore can not be timely so that women infected with HIV or pregnant women taking antiviral medication not standardized, so that the mother of the AIDS the effect of child transmission interventions. However, it now appears, in our hospital more than 200 cases of AIDS maternal physical examination of infants born HIV tested negative, that is, the proportion of PMTCT success being 100%. " Pang Chun stressed the "temporary." "Because these mothers after the birth of a child is not infected with either HIV virus, or is already infected, even for a standardized and effective comprehensive intervention for pregnant women suffering from AIDS, the risk of still birth to unhealthy babies."
Intrauterine infection, intrapartum infection, breast-feeding mother to child transmission of AIDS in three key areas. Therefore, prevention of mother infected with HIV transmit the virus to the fetus, newborn during delivery to prevent HIV infection, to prevent infection with the AIDS virus in infants breast-feeding mothers infected with HIV, mother to child transmission of AIDS as the key block. As the most vulnerable to maternal infection during childbirth, the closer confinement, the greater the risk. If you can use antiviral drugs to reduce HIV, the mother, the children will reduce the risk of infection, early detection and early treatment will have a good blocking effect. However, many pregnant women until delivery was only detected in HIV-positive prior to the loss of the timing of antiretroviral therapy during pregnancy.
According to reports from around our region into the Fourth People's Hospital of Nanning City, the AIDS pregnant women, over 40% of production in the third trimester and even when found to be infected with the HIV virus. This allows the face of AIDS PMTCT such a situation: You Sicheng HIV pregnant women in our region lost at least regulate the possibility of antiviral therapy. To this end, Pang Chun called: HIV-infected pregnant women has been a smooth delivery if you want children, should be implemented as soon as possible to the hospital for PMTCT initiative. She suggested that the emphasis on premarital unmarried young men and women, attention to HIV testing. Pang Chun said: "We said 'a healthy baby', not only that children infected with HIV, and other bodily functions is healthy, children physical development is normal, but also in pregnant women themselves and their families rely on children to actively monitor and check and treatment. "
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