妊娠合并先天性心脏病伴肺动脉高压患者的围产结局分析  

Perinatal outcomes of 45 pregnant women with pulmonary hypertension complicating congenital heart disease

作　　者：孟媛[1] 黄引平[1] 刘小利[1] 黄艳君[1] 周洁[1] 熊春秋[1] 吴丽群[1] 王波[1] 蔡彩萍[1] 

机构地区：[1]温州医学院附属第一医院妇产科,325000

出　　处：《中华妇产科杂志》2007年第10期662-665,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨妊娠合并先天性心脏病(先心病)伴肺动脉高压患者的围产结局。方法收集1995年4月至2007年5月温州医学院附属第一医院产科收治的45例妊娠合并先心病伴肺动脉高压患者的临床资料,根据肺动脉压力情况分为轻度组29例[30～49 mm Hg(1 mm Hg=0.133kPa)],中度组8例(50～79 mm Hg),重度组8例(≥80 mm Hg),分析各组先心病的种类、心功能级别、终止妊娠孕周和方式、先心病术后妊娠的安全性以及围产结局。结果 (1)先心病种类中以房间隔缺损、室间隔缺损为主,发生率为58%(26/45)。孕前行心脏矫正手术13例(29%,13/45),以轻度肺动脉高压、心功能Ⅰ～Ⅱ级为主。(2)轻度组心功能Ⅰ～Ⅱ级者28例,中度组心功能Ⅰ～Ⅱ级者6例,重度组心功能Ⅲ～Ⅳ级者7例。(3)轻度组足月分娩27例、难免流产1例、早产1例,新生儿平均出生体重为(3153±399)g;中度组足月分娩5例,早产3例;重度组足月分娩5例,医源性终止妊娠1例,早产2例;中、重度组新生儿平均出生体重明显低于轻度组,差异有统计学意义(P<0.05),同时中、重度组胎儿结局不良。(4)妊娠合并先心病伴肺动脉高压患者的分娩方式以剖宫产分娩为主,占78%(35/45),其中轻度组剖宫产分娩22例(22/29),中度组6例(6/8),重度组7例(7/8)。(5)45例患者中有11例于孕前或产后出现心功能衰竭早期表现或心功能衰竭,均分布在中、重度组,且心功能均为Ⅲ～Ⅳ级。其中2例死亡。结论妊娠合并先心病伴肺动脉高压患者的肺动脉压力越高,围产结局越差;孕前行心脏矫正手术后的先心病患者以轻度肺动脉高压为主,且围产结局良好;以剖宫产术终止妊娠是比较安全的分娩方式。Objective To explore the perinatal outcomes of women with pulmonary hypertension complicating congenital heart disease（CHD）. Methods Clinical data of 45 cases of pregnant women with pulmonary hypertension complicating CHD from Apr 1995 to May 2007 were analyzed and they were divided into three groups： 29 cases of slight group [pulmonary hypertension of 30 mm Hg （1 mm Hg =0. 133 kPa） to 49 mm Hg] , 8 cases of moderate group （ pulmonary hypertension of 50 mm Hg to 79 mm Hg） and 8 cases of severe group （pulmonary hypertension equal to or higher than 80 mm Hg）. The types of CHD, cardiac functional status （New York heart association, NYHA）, gestational weeks of pregnancy termination, mode of delivery, pregnancy after CHD operation and outcomes of infants were compared between the groups. Results （1）The highest incidence of CHD were atrial septal defect and ventricular septal defect （58%, 26/45）. The rate of pregnant women after CHD operation was 29% （13/45）, they were mainly in slight group and their NYHA class were in Ⅰ - Ⅱ. （2）The occurrence rate of NYHA class Ⅲ - Ⅳ was 7/8 in severe group. The rate of NYHA class Ⅰ - Ⅱ was 6/8 in moderate group. The rate of NYHA class Ⅰ - Ⅱ was 97% （28/29） in slight group. （3） The rate of term delivery was 93% （27/29）, preterm labor 3% （ 1/29 ）, abortion 3 % （ 1/29 ）, and the birth weight was （3153 ± 399 ） g on average in slight group. The rate of term delivery was 5/8, preterm labor occurred in 3 cases in moderate group. The rate of term delivery was 5/8, preterm labor occurred in 2 cases, and iatrogenic abortion in 1 case in severe group. The average birth weight between slight group and moderate or severe group had a significant difference. （4） Caesarean section rate was 78% （35/45） among all patients. The rate of cesarean section delivery was 76% （22/29） in slight group,6/8 in moderate group, and 7/8 in severe group. （5）The rate of pregnant women who had portent heart failure or heart

关 键 词：妊娠并发症 心血管 心脏缺损 先天性 高血压 肺性 围产结局 

分 类 号：R714.2[医药卫生—妇产科学]