妊娠合并心脏病患者的外科手术策略  

Surgical management of cardiac surgery during pregnancy

作　　者：陈劲进 肖颖彬 王咏 王伟 彭晓波 陈祥舟 CHEN Jin-jin;XIAO Ying-bin;WANG Yong;WANG Wei;PENG Xiao-bo;CHEN Xiang-zhou(Department of Cardiovascular Surgery Institute of PLA,Second Hospital Affiliated to Army Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院全军心血管外科研究所,重庆400037

出　　处：《局解手术学杂志》2019年第5期361-364,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：国家科技部十三五慢病课题(2016YFC1300);重庆市科委科技攻关课题(cstc2015shmsz)

摘　　要：目的探讨妊娠期行心内直视手术的方法与策略,改善孕妇及胎儿的预后。方法回顾性分析2016年1月至2018年12月我院7例妊娠期合并心脏病患者的临床资料,并对孕妇及婴儿进行随访。结果 7例孕妇中有4例为瓣膜病或先天性心脏病合并亚急性感染性心内膜炎,1例风湿性瓣膜病,2例急性主动脉夹层(A型)。术前心功能分级(纽约心脏病协会,NYHA)Ⅲ级2例,Ⅳ级5例。接受心脏手术时间是24～37孕周(中位数29孕周)。3例同期接受剖腹产及心内直视手术; 3例先进行心内直视手术,然后继续妊娠到足月后剖腹产取胎; 1例孕妇在24孕周时接受心脏手术,胎儿在手术前已宫内死亡,术后2 d自然娩出,孕妇术后15 d死亡;其余孕妇及胎儿随访1～23个月(中位数9个月),孕妇生活质量改善,心功能恢复到Ⅰ级,所有新生儿均存活。结论孕期行心内直视手术安全可行,手术时机的选择是决定孕妇及胎儿预后的重要因素。Objective To explore the strategy and treatment of open hearty surgery for pregnant woman to improve the maternal and fetal outcomes. Methods The perioperative data of 7 pregnant women with heart diseases in our hospital from January 2016 to December 2018 were retrospectively analyzed,meanwhile all the mothers and newborns were followed routinely. Results Among 7 patients,there were 4 case of subacute bacterial endocarditis associated with rheumatic valve disease or congenital heart disease,1 case of rheumatic valve disease and 2 cases of acute Stanford type A aortic dissection. According to New York Heart Association( NYHA) functional class,2 were in Ⅲ and 5 were in Ⅳ. The gestational age of pateints received cardiac surgery ranged from 24 to 37 weeks( median 29 weeks),3 patients had undergone caesarean section combined with cardiac surgery;3 patients had undergone cardiac surgery firstly,and then chose to continue pregnancy to full term,and then caesarean section was performed;1 patients with 24 weeks of gestational age had undergone cardiac surgery,the fetal was dead in the uterus preoperative and spontaneous abortion in 2 days postoperative,the mater was dead in 15 days postoperative. The remaining mothers and newborns were followed up for 1 to 23 months( median 9 months),the quality of life of the mothers were improved and the cardiac function recovered to functional class Ⅰ,the newborns were alive. Conclusion Cardiac surgery during pregnancy is associated with acceptable maternal and fetal mortality. Timing of the surgery is very important for the outcome of fetal and maternal.

关 键 词：体外循环 妊娠期 瓣膜病 先心病 亚急性感染性心内膜炎 主动脉夹层 心内直视手术 

分 类 号：R654.2[医药卫生—外科学]