妊娠合并心脏病伴肺动脉高压43例临床分析  

Clinical analysis of pregnant women with pulmonary hypertension complicating cardiac diseases in 43 cases

作　　者：岳军[1] 谢兰[1] 陈廉[1] 林丽[2] 

机构地区：[1]四川省医学科学院.四川省人民医院妇产科,四川成都610072 [2]成都军区空军司令部门诊部

出　　处：《中国计划生育和妇产科》2011年第4期45-48,共4页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的探讨妊娠合并心脏病伴肺动脉高压(pulmonary hypertension,PH)患者的母婴结局。方法收集2003～2010年四川省人民医院产科收治的43例妊娠合并心脏病伴PH患者的临床资料,分析各组心脏病种类、心功能级别、终止妊娠孕周和方式以及母儿结局。结果①轻度组患者中,妊娠及分娩期维持心功能Ⅰ～Ⅱ级者16例,Ⅲ～Ⅳ级者5例;中度组心功能Ⅰ～Ⅱ级者8例,Ⅲ～Ⅳ级者6例;重度组心功能Ⅰ～Ⅱ级者1例,Ⅲ～Ⅳ级者7例。②轻度组足月妊娠18例,早产3例;中度组足月分娩6例,早产5例,医源性流产3例;重度组孕产妇死亡3例,早产4例,医源性流产1例。3组发生新生儿窒息分别为5例、3例及4例。③妊娠合并心脏病患者的分娩方式以剖宫产为主,占76.74%(33/43)。结论随着肺动脉压力的升高,孕妇心功能衰竭的发生率增加,围产儿疾病发生率和胎儿丢失率也明显增加;手术终止妊娠是比较安全的分娩方式。Objective To study the pregnancy outcome of women with pulmonary hypertension （PH） complicating cardiac diseases. Methods Clinical data from 43 pregnant women with PH complicating cardiac diseases including the types of heart diseases, cardiac functional status （ New York heart association, NYHA） , gestational weeks of pregnancy termination, mode of delivery and outcomes of infants from Jan 2000 to Dec 2010 in Sichuan Provincal People＇s Hospital were analyzed. Results ①The rate of NYHA class Ⅲ～Ⅳ was 23.81% （5/21） in slight group. The rate of NYHA class Ⅲ～Ⅳ was 42. 86% （6/14） in moderate group. The occurrence rate of NYHA class Ⅲ～Ⅳ was 87. 50% （7/8） in severe group. ②The rate of term delivery, preterm labor was 85.71% （18/21 ）, 14. 29% （3/21 ） respectively in slight group. The rate of term delivery, preterm labor, iatrogenic abortion was 42. 86% （6/14）, 35.71% （5/14） , 21.43% （3/14） in moderate group. The rate of death, preterm labor, iatrogenie abortion was 37.50% （3/8）, 50.00% （4/8）, 12. 50% （1/8） in severe group. ③The rate of eesarean section was 76. 74 % （ 33/43 ）. Conclusion The rate of cardiac funetional failure increases gradually with the severity of pulmonary hypertension. The rate of maternal mortality and fetal loss increases in pregnant women with pulmonary hypertension complicating cardiac diseases. Cesarean section is safe to terminate pregnancy for those women.

关 键 词：妊娠并发症 心脏病 肺动脉高压 妊娠结局 

分 类 号：R714.25[医药卫生—妇产科学]