妊娠合并先天性心脏病患者临床特点分析  

Clinical analysis of pregnant women with congenital heart disease

作　　者：王以新[1] 李晓蕾[1] 殷玲[1] 曾汝园 冯妍[1] 

机构地区：[1]首都医科大学附属北京安贞医院全科医疗科,100029

出　　处：《中国医药》2015年第10期1512-1516,共5页China Medicine

摘　　要：目的 分析妊娠合并先天性心脏病患者的临床特点.方法 选取2013年1月至2014年6月在首都医科大学附属北京安贞医院分娩的妊娠合并先天性心脏病患者共147例为观察组,其中心功能Ⅰ级30例,心功能Ⅱ级95例,心功能Ⅲ～Ⅳ级22例.随机抽取50名同期在院分娩没有妊娠合并症的正常产妇为对照组.收集2组产妇临床资料,进行回顾性分析.结果 观察组患者中房间隔缺损所占比例最高,为34.7％ （51/147）,其次是室间隔缺损,占21.8％ （32/147）,再次是动脉导管未闭,占11.6％（17/147）.147例观察组患者中孕前行心脏手术70例,占47.6％;孕前未行心脏手术患者77例,占52.4％.观察组患者中心功能Ⅲ～Ⅳ级者剖宫产率高于心功能Ⅰ、Ⅱ级者[100.0％（22/22）比50.0％（15/30）、81.1％ （77/95）],差异有统计学意义（x2=20.118,P ＜0.05）.行剖宫产术的观察组患者剖宫产指征中心脏因素占59.6％（68/114）,产科因素占36.8％（42/114）.心功能Ⅲ～Ⅳ级观察组患者的麻醉方式中连续硬膜外阻滞麻醉占68.2％ （15/22）.对照组新生儿体质量明显高于观察组心功能Ⅰ、Ⅱ、Ⅲ～Ⅳ级患者[（3 455±397）g比（3 316±429）、（3 117±482）、（2 258±800）g],差异有统计学意义（P＜0.05）;观察组心功能Ⅲ～Ⅳ级患者新生儿体质量明显低于心功能Ⅰ、Ⅱ级患者,差异有统计学意义（P＜0.05）.对照组未发生早产儿、低体质量儿和新生儿窒息;观察组早产儿24例,低体质量儿21例,新生儿窒息9例.对照组未发生肺动脉高压和早产,观察组产妇并发症中肺动脉高压占比最高,为26.5％（39/147）,其次为早产,为16.3％（24/147）.结论 妊娠合并先天性心脏病的类型中位于前3位的是房间隔缺损、室间隔缺损和动脉导管未闭;易发生肺动脉高压和早产.Objective To analyze the clinical features of pregnant women with congenital heart disease （CHD）.Methods Totally 147 pregnant women with congenital heart disease （CHD） （observation group） from January 2013 to June 2014 were retrospectively analyzed;in them,30 cases were NYHA-grade Ⅰ,95 cases were grade Ⅱ and 22 cases were grade Ⅲ-Ⅳ.Fifty healthy pregnant women at the stane period were set as control group by random selection.The data were collected and compared between the two groups.Results In observation group,the proportion of atrial septal defect was the highest,being 34.7% （51/147）,followed by ventricular septal defect [21.8% （32/147）] and patent ductus arteriosus [11.6% （17/147）].Totally 47.6% （70/147） pregnant women in observational group underwent heart surgery before pregnancy,the others 52.4% （77/147） did not.The rate of cesarean delivery in pregnant women with NYHA grade Ⅲ-Ⅳ was significantly higher than that in those with NYHA grade Ⅰ and Ⅱ [100.0% （22/22） vs 50.0% （15/30）,81.1% （77/95）] （x2 =20.118,P 〈0.05）.In pregnant women who underwent cesarean delivery in observation group,59.6% （68/114） made this choice due to CHD and 36.8% （42/114） due to obstetrical factors.Totally 68.2% （15/22） of pregnant women with NYHA grades Ⅲ-Ⅳ received continuous epidural anesthesia.The neonate weight in control group was significantly greater than that in observational group （NYHA grades Ⅰ,Ⅱ,Ⅲ-Ⅳ） [（3 455 ± 397） g vs （3 316 ±429）,（3 117 ±482）,（2 258 ±800） g] （P 〈0.05）;the weight of neonate of pregnant women with NYHA grades Ⅲ-Ⅳ was significantly less than that of those with NYHA grades Ⅰ and Ⅱ （P 〈 0.05）.No preterm delivery,fetal growth restriction and asphyxia neonatorum occurred in control group;while in observation group,there were 24 cases of preterm delivery,21 cases of fetal growth restriction and 9 cases of asphyxia neonatorum.There were no pulmonary arterial hypertension in contro

关 键 词：妊娠合并先天性心脏病 心功能 妊娠结局 并发症 

分 类 号：R714.2[医药卫生—妇产科学]