87例妊娠合并心衰的临床分析  

Clinical Analysis of 87 Cases of Pregnant Women Complicated with Heart Failure

作　　者：施君[1] 狄文[1] 洪素英[1] 

机构地区：[1]上海交通大学医学院仁济医院妇产科,上海200001

出　　处：《上海交通大学学报（医学版）》2006年第12期1393-1395,共3页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的认识妊娠合并心衰的母婴危险，探讨妊娠合并各种心衰不同的处理原则。方法收集1993年3月～2006年1月87例妊娠合并心衰患者的病史资料。回顾性分析心衰发生的原因、发生的孕周、不同病因所致心衰的处理重点及相应的妊娠结局。结果①87例妊娠合并心衰的病因中合并风心31例（占35．6％），妊高征心衰26例（占29．9％），合并先心16例（占18．4％），围产期心肌病心衰14例（占16．1％）。②发生心衰的平均孕周是（32．69±5．57）周。③终止妊娠的平均孕周是（34．66±4．52）周。④新生儿79例（双胎6例），围产儿死亡8例（8．6％），孕中期剖宫取胎6例；平均新生儿体质量（2419．56±786．08）go⑤围产期孕产妇死亡6例（6．9％）。结论妊娠合并心衰的主要原因依次是妊娠合并风心、妊高征和先心。妊娠合并充血性心衰的治疗原则是强心、利尿、扩血管，但是必须根据不同病因作特殊处理，治疗有侧重，同时还要考虑胎儿的问题。明确妊娠合并心衰的原因，及时正确处理妊娠合并心衰，有利于降低围产期孕产妇和围产儿的死亡率。Objective To investigate the dangers of heart failure to the mother and fetal, and the diagnosis and treatment of pregnancy complicated with heart failure. Methods The clinical data of the causes, timing, management and outcomes of 87 cases of pregnant women complicated with heart failure from March 1993 to January 2006 were analyzed retrospectively. Results ①Thirty-one cases （35.6%） of heart failure in pregnancy were caused by rheumatic heart disease, 26 （29.9%） by pregnancy-induced hypertension （PIH） , 16 （18.4%） by congenital heart disease, and 14 （16.1%） by peripartum cardiomyopathy. ②The heart failure appeared at the average of （32.69 ±5.57） weeks. ③The average terminal time of pregnancy was （34.66 ±4.52） weeks. ④There were 79 newborns with 6 cases of twins, and the perinatal mortality was 8.6% （8 cases）. Hysterotomy was performed in 6 cases in midpregnancy. The average weight of babies was （2419.56 ±786.08） g. ⑤The maternal mortality was 6.9% （6 cases）. Conclusion The main causes of heart failure in pregnancy are rheumatic heart disease, PIH and congenital heart disease. Although the standard management of pregnancy complicated with heart failure is inotropic agents, diurectics and vasodilators, the treatment should be individualized according to the specific etiology and with the consideration of the safety of fetus as well. Pinpointing the causes of heart failure in pregnant patients and treating accordingly may be conducive to reduce the maternal and perinatal mortality.

关 键 词：妊娠 风湿性心脏病 妊高征 

分 类 号：R714.2[医药卫生—妇产科学]