妊娠合并无结构性心脏病心律失常877例临床分析  

A Retrospective Analysis of 877 Cases of Pregnant Women with Arrhythmias Associated with Structurally Normal Heart

作　　者：傅勤[1] 林建华[1] 

机构地区：[1]上海交通大学医学院附属仁济医院,上海200127

出　　处：《实用妇产科杂志》2016年第8期601-604,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的：探讨妊娠合并无结构性心脏病心律失常患者的治疗及妊娠结局。方法：收集1993年1月至2014年12月在上海交通大学医学院附属仁济医院分娩的877例无结构性心脏病心律失常患者的临床资料,对心律失常类型、治疗及妊娠结局进行分析。结果：877例妊娠合并心律失常以室性早搏最为常见（456例,占52.0%）,其次为窦性心动过速（182例,占20.8%）。患者足月分娩819例（93.4%）。孕期心功能Ⅰ-Ⅱ级者占99.4%（872/877）,Ⅲ-Ⅳ级者0.6%（5/877）;178例（20.4%）心功能Ⅰ-Ⅱ级患者予抗心律失常治疗,而5例（100.0%）心功能Ⅲ-Ⅳ级患者均予抗心律失常治疗;心功能Ⅲ-Ⅳ级者平均分娩孕周明显短于Ⅰ-Ⅱ级（38.8±1.4周vs 37.7±1.7周,P〈0.001）,围生儿不良结局发生率明显高于Ⅰ-Ⅱ级（8.0%vs 100.0%）。结论：无结构性心脏病心律失常患者以早搏居多,大部分患者心功能状态良好,能够耐受妊娠,经抗心律失常治疗后妊娠结局良好。Objective：To explore the treatment and pregnancy outcomes of pregnant women with arrhythmias in the absence of structural heart disease among different New York Heart Association（NYHA） functional classifi- cation. Methods：We retrospectively reviewed 877 cases of pregnant women with cardiac arrhythmias who delivered at Renji Hospital from January 1993 to December 2014. The cardiac arrhythmias type,treatment and preg-nancy outcomes of the cases were analyzed. Results：Of the 877 enrolled pregnant women with cardiac arrhyth- mias, the most common type during pregnancy was premature contraction（ n =456,52.0% ）, followed by sinus tachycardia （ n = 182,20.8% ）. Among the 877 patients,819 patients （93, 4% ） underwent full-term delivery. Based on the NYHA function class,872/877 patients（99.4%） were with NHYA functional class I - ]] and 5/877 patients（0.6%） were with NHYA functional class Ⅲ-Ⅳ. 178（20.4% ） patients with NHYA functional class Ⅰ-Ⅱ and 5 （100.0%） patients with NHYA functional class Ⅲ-Ⅳ were respectively treated with anti-arrhythmia medi- cine. Compared to patients with NYHA Ⅰ-Ⅱ ,the shorter mean gestational weeks at delivery（38.8 ± 1.4 gesta- tional weeks vs 37.7± 1.7 gestational weeks, P 〈 0. 001 ） and higher adverse perinatal outcome were in those with NYHA Ⅲ-Ⅳ （8.0% vs 100.0% ）. Conclusions.The most common type of patients with arrhythmias in the absence of structural heart disease is premature contraction, most patients have good heart function, and can suc- cessfully go through pregnancy. Even some cases with NHYA functional class Ⅰ-Ⅱ have symptoms,after treat-ment with anti-arrhythmia medicine,their pregnancy outcomes are better than those with NHYA functional class Ⅲ-Ⅳ.

关 键 词：无结构性心脏病 心律失常 妊娠结局 

分 类 号：R714.252[医药卫生—妇产科学]