妊娠合并胸痛13例临床分析  

Chest pain during pregnancy： a clinical analysis of 13 cases

作　　者：徐霞[1] 潘剑榕[1] 周瑜[1] 张延珍[1] cases XuXia;Pan Jianrong;Zhou Yu;Zhang Yanzhen(Department of Obstetrics and Gynecology,Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院妇产科,福州350001

出　　处：《中华围产医学杂志》2018年第9期610-614,共5页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨妊娠合并胸痛的临床特点及处理、妊娠结局及预后。方法回顾性分析2013年1月至2017年12月福建医科大学附属协和医院收治的13例妊娠合并胸痛患者的临床资料。结果（1）13例妊娠合并胸痛患者中，急性胸痛（发生〈72h）9例，亚急性（72h-〈30d）和慢性胸痛（≥30d）各2例。（2）l3例中，6例（例1-6）胸痛原发疾病为主动脉夹层，1例（例7）为心肌梗死，1例（例8）为横结肠癌，l例（例9）为自发性气胸，1例（例11）为反流性食管炎，1例（例12）考虑为肋间神经痛，1例（例13）为急性白血病，1例（例10）考虑为特发性。（3）8例剖宫产，3例（例8、10、12）阴道分娩，2例（例7、13）人工流产或引产。（4）l例主动脉夹层患者（例2）剖宫产＋主动脉术后出现感染性休克、多功能脏器衰竭自动出院后死亡。例7为急性心肌梗死患者，支架置人12d后行人工流产术，出院后失访；例13为急性白血病患者，化疗2个疗程并行引产术后，返当地医院治疗，之后失访。其余10例患者随访未见异常。（5）11例新生儿中，7例为早产儿。这7例早产儿中，例8在11月龄随访时见发育迟缓，其余6例早产儿和4例足月儿随访时均未见异常。结论妊娠合并胸痛病因较多，导致胸痛疾病的严重程度差异大，可能引起母婴死亡。临床上，对妊娠合并胸痛患者应及时诊断，积极干预，改善预后。Objective To investigate the clinical feature, management, outcome and prognosis of chest pain during pregnancy. Methods Clinical data of 13 gravidas with chest pain admitted to the Fujian Medical University Union Hospital from January, 2013 to December, 2017 were analyzed retrospectively. Results Among the 13 cases, nine had acute chest pain （happen within 72 hours）; two had chronic chest pain lasting over one month, and the other two had paroxysmal subacute chest pain （72 h to less than 30 d）. Seven cases were complicated by cardiogenic disease/death including six with aortic dissection （patients No.l-6） and one with myocardial infarction （patient No.7）. The remaining six cases were complicated by a variety of different noncardiac conditions including transverse colon cancer （patient No.8）, spontaneous pneumothorax （patient No.9）, reflux esophagitis （patient No. 11）, intercostal neuralgia （patient No. 12）, acute leukemia （patient No.13） and idiopathic disease （patient No. 10）. Eight women underwent cesarean section, three delivered vaginally （patients No.8, No.10 and No.12）, and two （patients No.7 and No.13） were aborted in the first trimester. Patient No.7 chose abortion in early pregnancy, 12 days after stent implantation, and was lost to follow up after discharge. Patient No. 13 underwent induced abortion following two courses of chemotherapy against acute leukemia and was also lost to follow up. Patient No.2 died due to the septic shock and subsequent multi-organ dysfunction syndrome after cesarean section and aortic surgery. The remaining ten cases did not report any abnormalities during follow- up. Among the 11 neonates, seven were preterm infants. All of the 11 babies were normal in followups except one preterm infant （case 8） showed growth retardation at 11 months old. Conclusions Chest pain during pregnancy may be caused by various reasons, and the severity varies greatly, and may even result in maternal and infant deaths in some circumstances. Early

关 键 词：妊娠 胸痛 主动脉夹层 预后 

分 类 号：R714.253[医药卫生—妇产科学]