晚孕期严重心脏病孕妇剖宫产术分娩同期心脏手术的可行性  

Feasibility study of single-stage cesarean section and cardiac surgery in pregnant women with severe heart disease in the third trimester

作　　者：龚静[1] 张军[1] Gong Jing;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：《中华妇幼临床医学杂志（电子版）》2022年第1期47-52,共6页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：北京市卫健委2019年医疗服务与保障能力提升项目(2019542)。

摘　　要：目的探讨晚孕期严重心脏病(SHD)孕妇剖宫产术分娩同期实施心脏手术的可行性。方法选择2012—2020年,首都医科大学附属北京安贞医院收治的21例剖宫产术分娩同期实施心脏手术的晚孕期SHD孕妇为研究对象。回顾性分析其一般临床资料、手术情况及母、儿妊娠结局。本研究遵循的程序符合本院医学伦理委员会要求,经过该伦理委员会批准(审批文号:2022027X)。结果①分娩时,21例SHD孕妇年龄为(30.8±4.0)岁、人体质量指数(BMI)为(25.0±5.6)kg/m2;分娩孕龄为(32.5±3.5)孕周,足月分娩为6例(28.6%);分娩22例新生儿,新生儿出生身长为(45.1±3.9)cm,出生体重为(2342.0±727.3)g,生后1、5及10 min Apgar评分分别为(7.4±2.5)分、(9.0±1.0)分和(9.6±1.0)分;新生儿存活率为100.0%(22/22)。②21例孕妇SHD类型中,主动脉夹层、胸/腹主动脉瘤、心包积液与心脏扩大分别为13例(61.9%)、7例(33.3%)、6例(28.6%)与5例(23.8%);13例(61.9%)为中、重度主动脉瓣关闭不全,19例(90.5%)为心功能分级≥Ⅱ级者;18例(85.7%)≥2种SHD。③21例SHD孕妇剖宫产术分娩同期由多学科团队(MDT)实施心脏手术术式为8种,心脏手术持续时间为(369.8±100.6)min,术中出血量为1157.4 mL(750.0~1550.0 mL);心肺转流术(CPB)时间为(139.0±45.1)min,术后存活率为100.0%(21/21)。结论对于晚孕期SHD孕妇,由MDT于剖宫产术分娩同期实施心脏手术可行,可为围生期产妇及新生儿生命安全提供保障。Objective To explore feasibility of single-stage cesarean section and cardiac surgery in pregnant women with severe heart disease(SHD)in the third trimester.Methods A total of 21 cases of pregnant women with SHD in the third trimester who received single-stage cesarean section and cardiac surgery in Beijing Anzhen Hospital,Capital Medical University from 2012 to 2020 were selected as research subjects.General clinical data,perioperative conditions and pregnancy outcomes of mothers and infants were retrospectively analyzed.The procedure followed in this study complied with requirements of the Medical Ethics Committee of Beijing Anzhen Hospital,Capital Medical University and was approved by the ethics committee(Approval No.2022027X).Results①At delivery,the age of 21 cases of SHD pregnant women was(30.8±4.0)years old,body mass index(BMI)was(25.0±5.6)kg/m2.Gestational age of delivery was(32.5±3.5)gestational weeks,including 6 cases(28.6%)of term delivery.22 newborns were born,and neonatal body length was(45.1±3.9)cm,body weight was(2342.0±727.3)g.Apgar scores of 1 min,5 min and 10 min after birth were(7.4±2.5)points,(9.0±1.0)points and(9.6±1.0)points,respectively.Neonatal survival rate was 100.0%(22/22).②In 21 cases of SHD pregnant women,there were 13 cases(61.9%)of aortic dissection,7 cases(33.3%)of thoracic/abdominal aortic aneurysm,6 case(28.6%)of pericardial effusion,and 5 cases(23.8%)of cardiac enlargement.Moderate and severe aortic regurgitation accounted for 61.9%(13/21),and 90.5%(19/21)of patients with cardiac function gradeⅡor above.18 cases(85.7%)had two or more kinds of SHD.③There were 8 kinds of cardiac operation in single-stage with cesarean section by multi-disciplinary team(MDT).The operation time of cardiac operation was(369.8±100.6)min and volume of blood loss was 1157.4 mL(750.0-1550.0 mL).Cardiopulmonary bypass(CPB)time was(139.0±45.1)min and all pregnant women survived.Conclusions For SHD pregnant women in the third trimester,it is feasible to perform single-stage cesarean sectio

关 键 词：妊娠并发症 心血管 心脏病 妊娠末期 心脏外科手术 妊娠结局 孕妇 

分 类 号：R71[医药卫生—妇产科学]