缺血性心脏病合并晚孕妇女的妊娠期管理与结局分析  

Pregnancy management and pregnancy outcome of pregnant women with pre-existing ischemic heart disease

作　　者：王焕英[1] 杨冬[1] 李燕娜[1] 刘文娴[2] 陈立颖[2] 徐晓辉[1] 张军[1] WANG Huanying;YANG Dong;LI Yanna;LIU Wenxian;CHEN Liying;XU Xiaohui;ZHANG Jun(Department of Obstetrics and Gynecology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所妇产科,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏内科重症中心,100029

出　　处：《心肺血管病杂志》2022年第6期635-639,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨既往缺血性心脏病(IHD)妇女的妊娠期管理和母胎结局。方法 :回顾性分析首都医科大学附属北京安贞医院2013年1月至2021年12月,收治的既往IHD妇女妊娠的临床资料,包括:年龄、孕周、IHD病史、症状、心功能、超声心动检查、母胎结局。结果 :15例既往IHD妇女妊娠,年龄26~42岁。10例BMI≥24kg/m^(2),12例高脂血症,3例高血压,3例糖尿病,1例有吸烟史,1例有家族史。妊娠前IHD发作18次,其中动脉粥样硬化15例次,冠状动脉痉挛2例次,冠状动脉血栓1例次。妊娠期心血管事件1例,孕36周出现轻微活动后胸闷。终止妊娠孕周37~40周,15例孕妇平安度过孕产期。15名新生儿,1例出生低体重儿,1例左肾重复肾畸形。结论 :既往IHD女性妊娠期有心脏事件发生,孕前或孕早期进行充分的妊娠风险评估,加强妊娠期高危因素的多学科管理,是保障母胎安全的重要措施。Objective: To investigate the pregnancy management and maternal and fetal outcome in pregnant women with pre-existing ischemic heart disease(IHD). Methods: We conducted a retrospective analysis of women with established IHD delivering between January 2013 and December 2021 in Beijing Anzhen Hospital, Capital Medical University. Data were collected on age, gestational age, maternal IHD history, clinical symptoms, cardiac function, echocardiography, obstetric and neonatal outcomes. Results: Fifteen women were identified aged between 26~42 years. There were 10 cases with BMI ≥ 24 kg/m^(2), 12 cases with hyperlipidemia, 3 cases with hypertension,3 cases with diabetes, 1 case with previous smoking, and 1 case with family history. There were 18 episodes of IHD before pregnancy in 15 women. The underlying IHD was due to atherosclerosis in 15/18, coronary artery spasm in 2/18 and thrombus in 1/18. There was one adverse cardiac events with chest tightness after slight activity at 36 weeks of pregnancy. Termination of pregnancy were between 37-40 pregnant weeks. All fifteen women were discharged from hospital safely.There were fifteen infants, of which there were one with low birth weight and one with malformation of left duplicate kidney. Conclusions: Women with pre-existing IHD have adverse cardiac events in pregnancy. Pregnancy risk assessment should be fully carried out before pregnancy or during early pregnancy. Strengthening multidisciplinary management to high risk factors during pregnancy and perinatal period is an important measure to ensure maternal and fetal safety.

关 键 词：缺血性心脏病 妊娠 妊娠风险评估 多学科管理 

分 类 号：R54[医药卫生—心血管疾病]