妊娠期高血压疾病性心脏病心力衰竭15例临床分析  

Clinical analysis of 15 cases of pregnancy induced hypertension heart failure

作　　者：魏炜[1] 王雅琴[1] 徐晓辉[1] 张军[1] 李燕娜[1] 

机构地区：[1]首都医科大学附属北京安贞医院妇产科,100029

出　　处：《中国妇产科临床杂志》2016年第1期40-43,共4页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的探讨妊娠期高血压疾病性心脏病心力衰竭的临床处理方法,分析孕期多学科管理对妊娠期高血压疾病性心脏病心力衰竭患者妊娠结局的影响。方法回顾性分析首都医科大学附属北京安贞医院2008年8月至2015年3月15例妊娠期高血压疾病性心脏病心力衰竭患者的心衰孕周、心功能、相关化验指标、孕期管理及母婴结局等临床资料。结果入组的15例患者均在孕期首次诊断妊娠期高血压疾病性心脏病心力衰竭,其中心功能Ⅲ级2例、Ⅳ级13例,产前患者14例,产后患者1例。入院后由产科、心内科、监护室、麻醉科、儿科等多学科协作制定个体化治疗方案,给予一般治疗,子痫前期重度的治疗,心力衰竭的治疗。14例产前患者中,2例患者孕21周行剖宫取胎术终止妊娠,1例25周行依沙吖啶引产终止妊娠,11例患者行剖宫产终止妊娠。经治疗15例患者均抢救成功。14例胎儿中2例剖宫取胎、1例依沙吖啶引产胎儿均死亡外,足月产5例,早产6例,11例新生儿均存活、无畸形,平均出生体重(2499±697)g,新生儿轻度窒息1例,低出生体重儿6例。结论加强孕期保健、恰当合理的治疗妊娠期高血压疾病,去除诱因,早期识别心功能不全,可以避免严重心力衰竭的发生;治疗方案应在利尿的基础上,适时的强心、扩血管控制心力衰竭,并适时终止妊娠。Objective To investigate the clinical treatment of gestational hypertension heart disease,and to analyze the impact of pregnancy multidisciplinary management on the pregnancy outcome.Methods A retrospective analysis was conduct of 15 cases with pregnancy-induced hypertension heart failure who were treated in Beijing Anzhen Hospital from August 2008 to March 2015.The data of gestational age,cardiac function,related laboratory indicators,clinical management,pregnancy outcomes were analyzed.Results All cases were first diagnosed during the pregnancy,2cases in heart function gradeⅢ,13 cases in Ⅳ.14 cases were prenatal patients,1case was postpartum patient.Multi-disciplinary team including obstetrics,cardiologist,ICU docters,anesthesiologist,pediatrics developed individualized treatment programs after admission.Among the 14 cases of prenatal patients,2patients underwent pregnancy termination at gestational age of 21 weeks,one case in 25 week received Li Stefano abortion to terminate the pregnancy,11 cases underwent cesarean section.15 patients were rescued successfully.Of the 14 fetus,3 lost before 28 weeks,5 were term delivery,6cases were premature delivery,11 cases of newborns were survived,no deformity was found,the average birth weight was（2499±697）g,1case was mild neonatal asphyxia,six cases were low birth weight.Conclusions Severe heart failure can be avoided by strengthen prenatal care,appropriately treatment of pregnancy induced hypertension and early identification of heart failure.Treatment should be on the basis of diuresis,timely strongthen heart function and expanding blood vessel to control heart failure,and termination of pregnancy if nessecery.

关 键 词：妊娠期高血压疾病性心脏病 心力衰竭 妊娠结局 

分 类 号：R714.252[医药卫生—妇产科学]