北京安贞医院妊娠合并心血管疾病十年临床资料分析  

Clinical analysis of pregnancy with cardiovascular diseases for a decade of Beijing Anzhen Hospital

作　　者：赵赫 张军[1] 张豪锋[1] 杨冬[1] 李燕娜[1] Zhao He;Zhang Jun;Zhang Haofeng;Yang Dong;Li Yanna(Department of Obstetrics and Gynecology,Beijing Anzhen Hospital,Capital Medical University,Obstetrics and Gynecology Center for Severe Cardiovascular Diseases,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心血管重症妇产医学中心,100029

出　　处：《中华妇产科杂志》2021年第8期528-536,共9页Chinese Journal of Obstetrics and Gynecology

基　　金：北京市卫生健康委员会医疗服务与保障能力提升项目(GWBYH[2019]542)。

摘　　要：目的分析首都医科大学附属北京安贞医院近10年妊娠合并心血管疾病孕妇的临床资料,探讨其发病和临床诊疗的变化趋势。方法收集2010—2019年于首都医科大学附属北京安贞医院住院分娩的妊娠合并心血管疾病孕妇的临床资料并进行回顾性分析。根据本中心成立多学科团队管理的时间,分为前5年组(2010—2014年)和后5年组(2015—2019年),分析两组孕妇的一般资料、妊娠合并心血管疾病的构成及母儿结局的变化。结果(1)2010—2019年间妊娠合并心血管疾病2267例(其中前5年组836例,后5年组1431例),总发生率为10.2%(2267/22334),各类心血管疾病中,心律失常(41.0%,930/2267)及先天性心脏病(38.2%,865/2267)较为常见。(2)前5年组和后5年组的改良版WHO孕妇心血管风险分类法分级为Ⅲ或Ⅳ级者分别为212例(25.4%,212/836)和426例(29.8%,426/1431),两组比较,差异有统计学意义(χ^(2)=5.076,P=0.024)。各类心血管疾病中,前5年组和后5年组瓣膜疾病孕妇分别为111例(13.3%,111/836)和159例(11.1%,159/1431),其构成比变化为-16.5%(变化的绝对值>10%为差异显著),有显著下降趋势;主动脉疾病孕妇分别为16例(1.9%,16/836)和56例(3.9%,56/1431),其构成比变化为105.3%,有显著上升趋势。(3)妊娠合并心血管疾病孕妇的病死率为1.0%(22/2267),其中前5年组和后5年组分别为1.2%(10/836)和0.8%(12/1431),两组比较,差异无统计学意义(χ^(2)=0.702,P=0.402)。前5年组和后5年组的ICU入住率分别为25.6%(214/836)和20.7%(296/1431),两组比较,差异有统计学意义(χ^(2)=7.306,P=0.007)。两组孕妇的剖宫产率、死亡率、不良事件发生率分别比较,两组新生儿出生体重、早产率、死亡率、窒息率分别比较,差异均无统计学意义(P均>0.05)。结论妊娠合并心血管疾病是不良产科结局的常见原因,其具体心血管疾病种类繁多、预后差异大,近年来疾病构成比有所变化,疾病严重和复杂程度增加,�Objective To analyze the clinical data of pregnant women complicated with cardiovascular disease in our center in the past 10 years,and to explore the trend of incidence,clinical diagnosis,and treatment of the disease.Methods Clinical data of pregnant women with cardiovascular disease who delivered in Beijing Anzhen Hospital,Capital Medical University from 2010 to 2019 were collected and analyzed retrospectively.According to the time of the establishment of multidisciplinary team(MDT)in the center,the pregnant women were divided into the first 5-year group(2010-2014)and the second 5-year group(2015-2019).The general data,the composition of pregnancy complicated with cardiovascular disease and the changes of maternal and infant outcomes of the two groups were analyzed.Results(1)During 2010-2019,there were 2267 cases of pregnancy complicated with cardiovascular disease(836 cases in the first 5-year group and 1431 cases in the second 5-year group),with a total incidence of 10.2%(2267/22334).Among all kinds of cardiovascular diseases,arrhythmia(41.0%,930/2267)and congenital heart disease(38.2%,865/2267)were more common.(2)There were 212 cases(25.4%,212/836)and 426 cases(29.8%,426/1431)classified as Ⅲ or Ⅳ by modified WHO cardiovascular risk classification in the first 5-year group and the second 5-year group,respectively,and the difference was statistically significant(χ^(2)=5.076,P=0.024).Among all kinds of cardiovascular diseases,there were 111 cases(13.3%,111/836)and 159 cases(11.1%,159/1431)with valvular disease in the first 5-year group and the second 5-year group,respectively.The change of the component ratio was-16.5%(the difference was significant when the absolute value of change>10%),showing a significant decreasing trend.Aortic disease was found in 16 cases(1.9%,16/836)and 56 cases(3.9%,56/1431),respectively,with a significant upward trend of 105.3%.(3)The mortality rate of pregnant women with cardiovascular disease was 1.0%(22/2267),and 1.2%(10/836)and 0.8%(12/1431)in the first 5-year grouop and the

关 键 词：妊娠并发症 心血管 心血管疾病 妊娠结局 回顾性研究 

分 类 号：R714.252[医药卫生—妇产科学]