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<td colspan="2" bgcolor="FFE3F3"> 更新时间：2008-6-20 15:05:39 【字体：<a href="javascript:fontZoomA();" class="top_UserLogin">小</a> <a href="javascript:fontZoomB();" class="top_UserLogin">大</a>】</td>
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临床上常见女性在孕期因自觉外阴瘙痒、灼痛、白带增多而去医院检查，被诊断患有念珠菌性阴道炎。该如何用药才不至于对胎儿有影响？ </P>
<P> <STRONG>念珠菌性阴道炎</STRONG>是生殖期妇女常见的外阴和阴道炎症之一，其主要症状是外阴瘙痒剧烈，伴有灼痛，白带增多且常呈白色豆渣样或凝乳状。一般来说，念珠菌性阴道炎多见于妊娠期妇女。这是由于妊娠期妇女的雌激素和孕激素水平较非孕期增高，使阴道上皮的含糖量增加，导致念珠菌得以大量繁殖和生长。若加之其它因素，如穿化纤内裤，或外阴部卫生不到位，或使用大量抗生素和激素等，其感染率则会更高。在临床上，妊娠中晚期合并念珠菌性阴道炎者必须及时诊治，以免导致一系列妊娠并发症，如早产、胎膜早破、绒毛膜羊膜炎及新生儿真菌感染等。首先，患者应注意选择对胎儿毒性小的抗念珠菌药物。目前认为咪唑类药物要优于制霉菌素，被认为是首要选择。这类药物包括克霉唑，氟康唑等，其中，以克霉唑最为安全、有效。患者可于睡前将１００ｍｇ的克霉唑置入阴道内。其次，要做到治必彻底，预防复发。妊娠期治疗念珠菌感染的时间要长于非妊娠期，治疗时间应至少延长７天，甚至２周。再次，患者必须积极祛除导致念珠菌性阴道炎复发的某些诱因，如不穿紧身裤、牛仔裤和化纤内裤等，宜穿宽松、透气性良好的棉布衣裤，避免使用大剂量激素或抗生素，重视会阴部保洁和防治糖尿病等。此外，在治疗期间，妊娠期妇女还应注意以下几点：①注意勤换内裤，最好一日一换，并将换下来的内裤用开水烫洗。②绝对避免性生活。若丈夫也有念珠菌感染应同时进行治疗。③到正规医院进行检查，并规抗真菌药。④以阴道用药为宜，重症患者可延长疗程，但尽量不要选用口服抗念珠菌药物，以使药物对胎儿的影响降至最小。 </P>
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毛舜英<br>
主任医师</p>
<p> 上海市妇女康复专业委员会委员，农工民主党党员，曾先后担任浙医大妇幼保健院妇产科医师、湖州市中心医院妇产科主任、湖州市第二届计划生育协会副会长，现任湖州阳光女子医院名誉院长、妇科主任。</p></td>
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