围生期心肌病和妊娠期高血压疾病性心脏病患者的鉴别诊断要点探讨  

Differential diagnosis of peripartum cardiomyopathy and heart disease related to hypertensive disorders

作　　者：王雁[1] 王曌[2] 魏俊[1] 张丽江[1] 刘国莉[1] 张晓红[1] 

机构地区：[1]北京大学人民医院妇产科,100044 [2]北京大学人民医院统计室,100044

出　　处：《中国妇产科临床杂志》2012年第2期100-103,共4页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的探讨围生期心肌病和妊娠期高血压疾病性心脏病的鉴别诊断要点。方法选择2001年1月至2010年10月间北京大学人民医院住院患者中,出院主要诊断为围生期心肌病(peripartumcardiomyopathy,PPCM;36例,PPCM组)和妊娠期高血压疾病性心脏病(26例,妊高心组)的患者,对与诊断相关的临床资料进行分析。结果 PPCM组以产后发病为主(86.11%,31/36),妊高心组以孕期发病为主(76.92%,20/26);超声心动图检查:PPCM组左心室舒张末期内径(left ventricular end-diastolic dimension,LVEDd)[(60.90±6.56)mm]高于妊高心组[(52.97±6.73)mm],PPCM组左心室射血分数(left ventricular ejection fraction,LVEF)[(32.44±7.95)%]则低于妊高心组(56.95±10.07)%],可合并右心改变(包括右房大、右室大、三尖瓣返流);胸片检查:PPCM组肺淤血比例(44.44%,12/27)高于妊高心组(0,0/15),妊高心组肺水肿比例(60.00%,9/15)高于PPCM组(14.81%,4/27);心电图检查:除窦性心动过速、ST-T改变外,PPCM组有7例患者合并其他心律失常(包括完全性右束支传导阻滞3例,房性心动过速、室性早搏、室性心动过速/室颤及Ⅱ度房室传导阻滞各1例),而妊高心组无1例发生;PPCM组B型脑利钠肽(B-type natriuretic peptide,BNP)水平[(1828.89±1220.06)pg/ml]高于妊高心组[(909.42±466.87)pg/ml]。结论与妊娠期高血压疾病性心脏病相比,PPCM以产后发病为主,超声心动图提示左心室扩大和功能减退更严重,胸片提示肺淤血为主,心电图除窦性心动过速、ST-T改变以外可合并其他的心律失常,BNP水平更高。Objective To analyze the differential diagnosis of peripartum cardiomyopathy（PPCM）and heart disease related to hypertensive disorders in pregnancy（HD-HDP）.Methods Sixty-two patients who were treated for PPCM（36 cases） or HD-HDP（26 cases） in Peking University People＇s Hospital from January 2001 to October 2010 were recruited.The clinical data related to the diagnosis were analyzed statistically.Results PPCM usually presented in postpartum period（86.11%,31/36）,but HD-HDP always in pregnant period（76.92%,20/26）.The left ventricular end-diastolic dimension（LVEDd） of PPCM was higher than that of HD-HDP [（60.90±6.56）mm vs（52.97±6.73）mm],but the left ventricular ejection fraction（LVEF） was lower [（32.44±7.95）% vs（56.95±10.07）%].Meantime,PPCM may be complicated with the right atrial and/or ventricular enlargement,or tricuspid regurgitation.Engorgement was the main appearance of chest films for PPCM（44.44%,12/27）,but pulmonary edema for HD-HDP（60.00%,9/15）.Various arrythmia in addition to nodal tachycardia and ST-T changes in electrocardiogram could be happened in PPCM,such as complete right bundle branch block,atrial or ventricular tachycardia,ventricular premature beat,ventricular fibrillation or II grade atrio-ventricular block.PPCM had higher levels of serum BNP than HD-HDP [（1 828.89±1 220.06）pg/ml vs（909.42±466.87）pg/ml].Conclusions Comparative to HD-HDP,PPCM always happens during postpartum,left ventricular enlargement and dysfunction are more serious,engorgement is the main appearance of chest film,various arrythmia in addition to nodal tachycardia and ST-T changes in electrocardiogram can be seen,and has higher serum BNP.

关 键 词：围生期心肌病 心血管并发症 妊娠 高血压 鉴别诊断 

分 类 号：R714.7[医药卫生—妇产科学]