妊娠期行心脏手术孕妇的胎儿结局:20例病例分析  

Fetal outcomes in pregnant women undergoing cardiac surgery during pregnancy: an analysis of 20 cases

作　　者：景赫[1] 卢家凯[1] 程卫平[1] 魏敏 王晟 Jing He;Lu Jiakai;Cheng Weiping;Wei Min;Wang Sheng(Department of Anesthesiology,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麻醉中心,北京100029

出　　处：《中华麻醉学杂志》2024年第4期412-417,共6页Chinese Journal of Anesthesiology

摘　　要：回顾性分析2012年1月至2022年12月在本院保留妊娠仅行心脏手术的20例孕妇病历资料,根据其胎儿结局分为2组:胎儿存活组和胎儿流失组。胎儿存活组11例,胎儿流失组9例。胎儿整体死亡率为45%。胎儿流失组中2例胎儿术中死亡,另7例于术后26(29)d死亡。胎儿存活组心脏病诊断以瓣膜病和感染性心内膜炎为主,胎儿流失组以A型主动脉夹层为主。胎儿存活组和胎儿流失组分别有2例、6例合并肺动脉高压,分别有2例、3例存在既往心脏手术史,分别有3例、5例行急诊手术。4例孕妇术中进行了深低温停循环,且均为胎儿流失组。胎儿流失组1例合并A型主动脉夹层孕妇于术后15 d死亡,母体整体死亡率为5%。母体心脏术后不良事件发生率为25%,均发生在胎儿流失组。保留妊娠仅行心脏手术孕妇的胎儿不良结局可能与A型主动脉夹层、肺动脉高压、再次心脏手术、急诊手术、深低温停循环、心脏术后不良事件,以及术后远期相关因素有关。The medical records from 20 pregnant women with pregnancy preservation who underwent only cardiac surgery in our hospital from January 2012 to December 2022 were retrospectively analyzed.The patients were divided into 2 groups according to the fetal outcome:fetal survival group and fetal loss group.Eleven patients were included in fetal survival group and 9 patients in fetal loss group.The overall fetal mortality rate was 45%.In fetal loss group,2 cases died during operation,and the other 7 cases died at 26(29)days after operation.The valvular disease and infective endocarditis were the most common heart diseases diagnosed in fetal survival group,while type A aortic dissection in fetal loss group.There were 2 cases and 6 cases with pulmonary hypertension,2 cases and 3 cases with a history of cardiac surgery,and 3 cases and 5 cases underwent emergency surgery in fetal survival group and in fetal loss group,respectively.Four pregnant women underwent deep hypothermic circulatory arrest in fetal loss group.One patient with type A aortic dissection died 15 days after cardiac surgery,with an overall maternal mortality rate of 5%in fetal loss group.The incidence of adverse events after maternal cardiac surgery was 25%,all of which occurred in fetal loss group.In conclusion,the adverse fetal outcomes may be related to type A aortic dissection,pulmonary hypertension,recardiac surgery,emergency surgery,deep hypothermic circulatory arrest,adverse events after cardiac surgery,and long-term related factors after surgery in pregnant women with pregnancy preservation undergoing cardiac surgery alone.

关 键 词：妊娠 心脏外科手术 胎儿 妊娠结局 

分 类 号：R654.2[医药卫生—外科学] R714.252[医药卫生—临床医学]