妊娠合并心脏病患者心脏不良事件危险因素分析  

An analysis of risk factors for postpartum cardiac events in pregnant women with heart disease

作　　者：周晓瑞[1] 卢家凯[2] 陈晓[1] 李强[1] 叶清[1] 孙建萍[1] 张京岚[1] 

机构地区：[1]北京市心肺血管疾病研究所首都医科大学附属北京安贞医院综合外科ICU,100029 [2]北京市心肺血管疾病研究所首都医科大学附属北京安贞医院麻醉科,100029

出　　处：《中华内科杂志》2013年第11期966-969,共4页Chinese Journal of Internal Medicine

基　　金：首都医学发展科研基金重点项目（2009-2073）

摘　　要：目的探讨心脏病孕产妇发生心脏不良事件的危险因素，为改善此类患者妊娠结局提供帮助。方法回顾性分析2004-2012年在首都医科大学附属北京安贞医院综合外科监护病房住院的围产期心脏病孕产妇的临床资料。采用单因素和多因素logistic回归分析心脏病孕产妇发生心脏不良事件的危险因素。结果190例孕龄≥20周心脏病孕产妇人选本研究，其中先天性心脏病134例（70．5％），风湿性心脏病30例（15．8％），心肌病10例（5．3％），围生期心肌病2例（1．1％），原发性高血压性心脏病14例（7．4％）。42例（22．1％）患者发生心脏不良事件。7例患者死亡，病死率3．7％。死亡原因为循环衰竭死亡4例；继发肺部感染，呼吸、循环衰竭死亡2例；风湿性心脏病二尖瓣置换术后患者，孕晚期瓣膜功能急性失调，急诊终止妊娠同时行二次换瓣术，术后因严重肺动脉高压、循环衰竭死亡1例。多因素logistic回归分析显示，孕前纽约心脏病协会心功能分级〉I级、产前左心室射血分数〈50％、产前应用血管活性药、重度肺动脉高压[肺动脉收缩压（SPAP）〉80mmHg（1mmHg=0．133kPa）]是心脏病孕产妇发生心脏不良事件的独立危险因素。结论心脏病孕产妇心脏不良事件发病率高，重度肺动脉高压（SPAP〉80mmHg）、孕前心功能差是导致心脏病孕产妇发生心脏不良事件的主要危险因素，临床工作中应加强对此类患者的密切监护及合理治疗。Objective To investigate the risk factors for postpartum cardiac events in pregnant women with heart diseases and to provide prenatal counseling for them. Methods A retrospective analysis was made in cases of pregnant women with heart diseases admitted to the surgical intensive care unit （SICU） of Anzhen Hospital from May 2004 to May 2012. Data were used to identify univariate and multivariate predictors for postpartum cardiac events. Results A total of 190 patients （ i〉 20 weeks gestation） were enrolled in the study with 134 （70. 5% ） of congenital heart disease, 30 （ 15.8% ） of rheumatic heart disease, 10 （5.3%） of eardiomyopathy, 2 （ 1.1% ） of peripartum cardiomyopathy and 14（7.4% ） of hypertensive heart disease. Postpartum cardiac events were observed in 42 cases with the incidence of 22. 1%. A total of 7 cases resulted in death with the mortality rate of 3.7%. Among them, 5 cases were dead of circulatory collapse and pulmonary hypertensive crisis postpartum, while the other 2 cases with secondary pulmonary infection were died of respiratory and circulatory collapse. The baseline parameters of New York Heart Academy（NYHA） 〉 1, left ventricular ejection fraction（LVEF） 〈 50% , use of cardiac drugs and pulmonary artery hypertension（PAH） 〉 80 mm Hg（ 1 mm Hg = 0. 133 kPa） were the independent predictors for postpartum cardiac events by univariate and multivariate logistic regression analysis. Conclusions The incidence of postpartum cardiac events is high in pregnant women with heart diseases. Pulmonary artery hypertension and heart failure are the main causes of death.

关 键 词：妊娠并发症 心血管 心脏不良事件 危险因素 

分 类 号：R714.252[医药卫生—妇产科学]