妊娠合并心脏病患者妊娠结局影响因素分析  

Influence factors of the pregnancy outcome in pregnant patients with heart disease

作　　者：张大伟[1] 王焕英[1] 李燕娜[1] 张军[1] 陈菲[2] 

机构地区：[1]首都医科大学附属北京安贞医院妇产科,北京100029 [2]首都医科大学附属北京安贞医院心脏监护室,北京100029

出　　处：《中华实用诊断与治疗杂志》2015年第6期574-576,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81171350)

摘　　要：目的探讨影响妊娠合并心脏病患者妊娠结局的因素。方法回顾性分析98例妊娠合并心脏病患者的临床资料,比较不同NYHA心功能分级、不同心脏病类型患者足月产、剖宫产、新生儿窒息发生情况及出生体质量。结果NYHA心功能分级Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者足月产比例分别为61.0%、39.4%、37.5%和12.5%,剖宫产率分别为46.3%、75.8%、87.5%、100.0%,新生儿窒息发生率分别为0、2.9%、12.5%、25.0%,新生儿出生体质量分别为(3 388.6±589.7)、(3 095.3±632.4)、(2 685.9±774.8)、(2 561.7±798.8)g,随心功能分级增高,足月产比例下降,剖宫产率和新生儿窒息发生率增高,新生儿出生体质量降低(P<0.05);心律失常患者孕周[(38.7±1.3)周]、足月产比例(84.2%)、自然分娩比例(78.9%)和新生儿出生体质量[(3 268.2±651.3)g]明显高于先天性心脏病[(35.2±2.7)周、17.6%、29.4%、(2 596.4±639.7)g]、风湿性心脏病[(34.8±2.5)周、34.8%、17.4%、(2 653.7±783.6)g]、妊娠高血压心脏病[(36.7±2.3)周、35.7%、7.1%、(2 723.8±577.2)g]和心肌病[(36.5±1.8)周、37.5%、25.0%、(2 859.8±673.5)g](P<0.05)。结论心功能分级、心脏病类型影响妊娠合并心脏病患者妊娠结局,临床应对妊娠合并心脏病患者进行风险分级管理,以减少不良妊娠结局的发生。Objective To explore the influence factors of the pregnancy outcome of pregnant patients with heart disease.Methods The data of 98 pregnant patients with heart disease were retrospectively analyzed.The term birth rate,cesarean section rate,incidence of neonatal asphyxia and birth mass were compared in patients with different types of heart disease and different NYHA grades.Results The term delivery rates were 61.0%,39.4%,37.5% and 12.5%,the caesarean section rates were 46.3%,75.8%,87.5% and 100.0%,the newborn asphyxia rates were 0,2.9%,12.5% and 25.0%,the birth masses were（3 388.6±589.7）,（3 095.3±632.4）,（2 685.9±774.8）and（2 561.7±798.8）g,respectively,in patients with NYHA gradeⅠ,Ⅱ,Ⅲ andⅣ.With the increase of heart function grades,the term birth rate decreased,the caesarean section rates and the incidence of newborn asphyxia rates increased,and the body mass of newborns decreased（p〈0.05）.The gestational week（（38.7±1.3）weeks）,term birth rate（84.2%）,the rate of spontaneous delivery（78.9%）and the body mass of newborns in patients with arrhythmia were higher than those in patients with congenital heart disease（（35.2±2.7）weeks,17.6%,29.4%,（2 596.4±639.7）g）,in patients with rheumatic heart disease（（34.8±2.5）weeks,34.8%,17.4%,（2 653.7±783.6）g）,in patients with gestational hypertensive heart disease（（36.7±2.3）weeks,35.7%,7.1%,（2 723.8±577.2）g）and in patients with myocardiopathy（（36.5±1.8）weeks,37.5%,25.0%,（2 859.8±673.5）g）（p〈0.05）.Conclusion NYHA grade and heart disease type are the factors influencing pregnancy outcomes of patients with heart disease.The pregnant patients with heart disease should be managed according to the risk stratification in order to reduce the incidences of bad pregnancy outcomes.

关 键 词：妊娠合并心脏病 妊娠结局 影响因素 

分 类 号：R714.252[医药卫生—妇产科学]