围产期心肌病诊治分析  

Diagnosis and management of peripartum cardiomyopathy

作　　者：计鸣良 戚庆炜[1] 汤萍萍[1] 胡惠英[1] 楼伟珍[1] 刘俊涛[1] 杨剑秋[1] 

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院妇产科,北京100730

出　　处：《生殖医学杂志》2016年第3期199-204,共6页Journal of Reproductive Medicine

摘　　要：目的通过分析围产期心肌病(PPCM)的临床特点,寻找帮助早期诊断的临床征象,并为临床确立治疗方案和选择分娩时机提供依据。方法回顾性分析北京协和医院确诊的27例PPCM患者的临床表现、诊断、治疗及预后。结果PPCM是妊娠最后1个月或产后5个月内发病,不明原因的心脏扩大和心功能衰竭,符合扩张型心肌病的诊断标准。我院分娩的孕产妇中PPCM发病率约为1/1 630(0.061%)。患者表现出心功能不全的症状及体征,超声心动图显示左心室射血分数显著减低,为(35.8±10.0)%,可伴有心电图异常和血清B型脑钠肽升高,还可合并妊娠期高血压等疾病。经积极地抗心力衰竭治疗,心功能多可改善。产前发病者早产率约为77.3%,终止妊娠以剖宫产为主,胎儿可出现胎死宫内、新生儿死亡、重度窒息等。结论 PPCM患者早期临床表现多不典型,超声心动图是重要的诊断依据。经及时正规的药物治疗和终止妊娠,PPCM患者心功能多可改善,孕产妇总体预后相对较好,但胎儿或新生儿不良结局风险高,故建议及时终止妊娠。Objective. To analyze the clinical features of peripartum cardiomyopathy （PPCM） in order to discover clinical signs for early diagnosis, and provide evidence for establishing treatment schedule and selecting delivery time. Methods： The data of clinical manifestations, diagnosis, treatment and prognosis of 27 patients diagnosed with PPCM in Peking Union Medical College Hospital were retrospectively analyzed. Results： PPCM is unexplained cardiomegaly and heart failure. PPCM usually occurs during the last month of pregnancy. The PPCM patients have unexplained cardiac enlargement and heart failure. The incidence of PPCM in our hospital was 1/1 630 （0. 061%）. The patients with PPCM manifested with signs and symptoms of cardiac insufficiency. The echocardiography results showed left ventricular ejection fraction （LVEF） decreased notably to （35.8± 10.0）%. Some patients had abnormal electrocardiogram result and elevation of serum brain natriuretic peptide, or accompanied with hypertensive disorder, even severe preeclampsia. Most patients had cardiac function improvement after regular anti-heart failure therapy. Among the patients with prenatal onset,the incidence of premature delivery was 77.3% ,and the most patients were terminated by caesarean section delivery. Unfavorable outcomes of fetus included intrauterine death, neonatal death and perinatal severe asphyxia. Conclusions. Early clinical manifestations of PPCM patients are atypical. Echocardiography is an important basis for the diagnosis of PPCM. Patients with PPCM have relatively favorable prognosis,however,the incidence o{ adverse {etal or neonatal outcome is high. Terminate pregnancy should be in time.

关 键 词：围产期心肌病 心力衰竭 

分 类 号：R541.6[医药卫生—心血管疾病]