妊娠合并右心感染性心内膜炎的临床特征与治疗:七例分析  

Clinical features and management of right-sided infective endocarditis during pregnancy:analysis of seven cases

作　　者：陈勇[1] 刘双[1] 朱光发[1] 李燕娜[2] 曹剑[3] 窦瑞雨[4] Chen Yong;Liu Shuang;Zhu Guangfa;Li Yanna;Cao Jian;Dou Ruiyu(Department of Respiration and Critical Care Medicine,Capital Medical University Affiliated Beijing Anzhen Hospital,Beijing 100029,China;Department of Obstetrics and Gynecology,Capital Medical University Affiliated Beijing Anzhen Hospital,Beijing 100029,China;Department of Cardiac Surgery,Capital Medical University Affiliated Beijing Anzhen Hospital,Beijing 100029,China;Department of Radiology,Capital Medical University Affiliated Beijing Anzhen Hospital,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院呼吸与危重症医学科,100029 [2]首都医科大学附属北京安贞医院妇产科,100029 [3]首都医科大学附属北京安贞医院心外科,100029 [4]首都医科大学附属北京安贞医院影像科,100029

出　　处：《中华围产医学杂志》2021年第8期584-590,共7页Chinese Journal of Perinatal Medicine

摘　　要：目的分析妊娠合并右心感染性心内膜炎的临床特征与治疗。方法回顾性分析2009年1月至2020年3月在首都医科大学附属北京安贞医院住院治疗的7例妊娠合并右心感染性心内膜炎患者的临床表现、血培养、超声心动图、诊治经过及母婴结局等资料。对数据采用描述性统计分析。结果(1)本单位同期妊娠合并右心感染性心内膜炎的发生率为0.27‰(7/25832)。7例患者年龄(26.0±2.7)岁,均有先天性心脏病史;发病孕周为(28.7±6.6)周,主要表现为心脏杂音、发热、呼吸困难、咳嗽、咳痰和肺部湿啰音。合并贫血7例,低蛋白血症7例,低氧血症6例,肺动脉高压5例。5例血培养阳性。(2)超声心动图发现赘生物主要位于肺动脉瓣(4例)、三尖瓣(3例)、右心室流出道(3例)。4例经胸部X射线片诊断为脓毒性肺栓塞。(3)所有患者进行静脉抗生素治疗。1例孕中期发生胎儿宫内死亡,行剖宫取胎术;5例孕晚期行剖宫产术;1例孕晚期经阴道分娩。4例住院期间行心脏手术治疗,其中2例心脏手术与剖宫产同期进行,2例在剖宫产术后行心脏手术;3例本次入院未行心脏手术。(4)7例患者住院26 d(12~76 d)。6例治愈,1例患者产后自动出院后死亡。6例新生儿中1例发生窒息,家属放弃治疗死亡,其余5例存活。随访5年(3~10年),这些儿童的生长发育未见明显异常。结论妊娠合并右心感染性心内膜炎临床少见且病情危重,需尽早诊断,制定最优治疗方案,降低母婴病死率。Objective To describe the characteristics and management of right-sided infective endocarditis(RSIE)during pregnancy.Methods The clinical manifestation,blood culture,echocardiography,diagnosis,treatment,and maternal and infant outcomes of seven patients with RSIE during pregnancy from Capital Medical University Affiliated Beijing Anzhen Hospital from January 2009 to March 2020 were retrospectively collected and described.Results The incidence of RSIE during pregnancy was 0.27‰(7/25832).All patients had a history of congenital heart disease,with a mean age of(26.0±2.7)years and a mean gestational age at onset of(28.7±6.6)weeks.Cardiac murmur,fever,dyspnea,cough,expectoration,and pulmonary rales were the common symptoms.Seven cases were complicated by anemia,seven with hypoproteinemia,six with hypoxemia,five with pulmonary hypertension,and five with positive blood culture.Echocardiography indicated that vegetations were mainly attached to the pulmonary valves(four cases),followed by the tricuspid valves(three cases)and the right ventricular outflow tract(three cases).Four patients were diagnosed with septic pulmonary embolism by chest X-ray.All patients were treated with intravenous antibiotics.Cesarean section was performed on five cases in the third trimester and one in the second trimester due to intrauterine death.The other case underwent vaginal delivery in the third trimester.Cardiac surgery was conducted during the hospitalization in four cases and not in the other three.The mean length of stay was 26 days(12-76 days).Six cases were cured,and one died after discharge.Among the six neonates,one had asphyxia and was died after withdrawal of treatment.The remaining five infants survived and developed well during the follow-up of 5 years(3-10 years).Conclusions Pregnancy complicated by RSIE is a rare and critical condition,requiring early diagnosis to make optimal treatment strategies,reducing maternal and infant fatality.

关 键 词：妊娠并发症 心内膜炎 妊娠结局 

分 类 号：R714.252[医药卫生—妇产科学]