167例妊娠合并心血管疾病患者妊娠早中期终止妊娠的临床分析  

Clinical analysis of pregnancy termination in 167 pregnant women with cardiovascular disease during the first and second trimester

作　　者：包照亮[1] 赵赫 张军[1] Bao Zhaoliang;Zhao He;Zhang Jun(Department of Obstetrics and Gynecology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

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：《中华妇产科杂志》2021年第6期418-424,共7页Chinese Journal of Obstetrics and Gynecology

基　　金：北京卫健委医疗服务与保障能力提升项目(20190542)。

摘　　要：目的分析妊娠合并心血管疾病患者在早中孕期终止妊娠的风险评估、方法选择及临床管理。方法以2016年1月至2019年9月首都医科大学附属北京安贞医院收治的妊娠合并心血管疾病在早中孕期终止妊娠的167例孕妇为观察对象,总结其临床特点、终止妊娠原因、终止妊娠方法、围术期管理和临床结局。结果167例妊娠合并心血管疾病患者中,早孕期119例(71.3%,119/167),中孕期48例(28.7%,48/167)。终止妊娠的原因为:心血管疾病109例(65.3%,109/167),非意愿妊娠54例(32.3%,54/167),其他原因4例。早孕期,负压吸引术98例,钳刮术19例,药物流产2例;终止妊娠后患者心功能均无变化,均存活。中孕期,依沙吖啶羊膜腔内注射引产16例,水囊引产2例,缩宫素静脉滴注引产1例,剖宫取胎术29例。中孕期行剖宫取胎术的患者中,心功能Ⅲ~Ⅳ级者的比例(79%,23/29)明显高于中孕期经阴道引产者(4/19;P<0.01);妊娠风险分级Ⅳ~Ⅴ级者的比例(100%,29/29)也明显高于经阴道引产者(14/19;P=0.007)。剖宫取胎术者术后住院时间[(7.1±3.4)d]明显长于经阴道引产者[(2.4±1.8)d;P<0.01]。中孕期依沙吖啶羊膜腔内注射引产者中有4例在引产后心功能有好转,术后恢复快,无严重并发症;剖宫取胎术者中有5例在术后心功能有不同程度下降,另有1例术后1 d死亡。结论妊娠合并心血管疾病患者应尽早进行妊娠风险评估;不宜继续妊娠者应尽早终止妊娠,减少风险。根据不同孕周及妊娠并发症和合并症选择终止妊娠方法及镇痛方式,不可随意放宽剖宫取胎术指征,尽量减少创伤、减少血流动力学变化。终止妊娠后应落实避孕措施并指导下一步的治疗。Objective To study the risk assessment,method selection and clinical management of pregnancy termination during the first and second trimester of pregnant women with cardiovascular disease.Methods This study focused on pregnant women with cardiovascular diseases who were admitted to Beijing Anzhen Hospital during the first and second trimester of pregnancy from January 2016 to September 2019,to summarize their clinical characteristics,reasons and methods of pregnancy termination,management and outcomes.Results Among 167 pregnant women,119 cases(71.3%,119/167)were in early pregnancy and 48 cases(28.7%,48/167)were in middle pregnancy.The reasons for termination of pregnancy were cardiovascular disease(109 cases;65.3%,109/167),unwanted pregnancy(54 cases;32.3%,54/167)and other reasons(4 cases).Vacuum aspiration was performed in 98 cases and forceps curettage was performed in 19 cases,medical abortion was performed in 2 cases in early pregnancy.There was no change in cardiac function after pregnancy termination and all survived in early pregnancy.In the second trimester,16 cases were induced by intraamniotic injection of ethacridine,2 cases by water balloon,1 case by oxytocin intravenous drip,and 29 cases by hysterotomy delivery.The ratio of patients with hysterotomy delivery with cardiac function gradeⅢ-Ⅳwas significantly higher than that in the patients with vaginal labor induction in the second trimester[79%(23/29)vs 4/19;P<0.01];the ratio of pregnancy risk gradeⅣ-Ⅴwas also significantly higher[100%(29/29)vs 14/19;P=0.007].The mean length of hospital stay of patients with hysterotomy delivery was significantly longer than that in the patients with vaginal labor induction[(7.1±3.4)vs(2.4±1.8)days;P<0.01].Cardiac function was improved in 4 patients induced by ethacridine and rapid recovery without serious complications.Cardiac function decreased in 5 cases and 1 case died on the first day after hysterotomy delivery.Conclusions Pregnancy risk assessment should be conducted as early as possible in patients w

关 键 词：妊娠并发症 心血管 妊娠初期 妊娠中期 流产 人工 引产 

分 类 号：R714.252[医药卫生—妇产科学]