危重症先天性心脏病孕产妇的临床特点及母儿预后单中心分析  

Characteristics and maternal-fetal outcomes of pregnant women with critical congenital heart disease from a single center in China

作　　者：王惠 朱春凤 韩凤珍 Wang Hui;Zhu Chunfeng;Han Fengzhen(Department of Obstetrics,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Southern Medical University,Guangzhou 510080,China)

机构地区：[1]南方医科大学附属广东省人民医院、广东省医学科学院产科,广州510080

出　　处：《中华妇产科杂志》2024年第7期513-521,共9页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨危重症先天性心脏病(先心病)孕产妇的临床特点、治疗方法及母儿预后。方法回顾性分析2008年1月1日至2020年12月31日广东省人民医院救治的入住重症监护病房(ICU)的危重症先心病孕产妇的临床资料。描述性分析其人口学特点、抢救策略、重症监护情况及母儿结局。结果(1)共纳入危重症先心病孕产妇132例,包括孕妇128例[孕周(28.0±8.8)周],产妇4例(产后6~32 d),63.6%(84/132)来自经济欠发达的农村地区,78.0%(103/132)由地市级及以下医院转诊入院,不规律产前检查者占59.1%(78/132)。先心病主要类型为分流型(55.3%,73/132)。改良版WHO(mWHO)风险分级Ⅳ级者占90.9%(120/132)。主要心血管并发症为肺动脉高压(64.4%,85/132)。46.2%(61/132)孕前已确诊先心病,70.5%(93/132)孕前未接受任何治疗。(2)所有危重症先心病孕产妇均接受了产科主导的多学科团队协作诊疗。抢救成功率96.2%(127/132),无严重产科并发症发生。至出院后24 h内死亡率为3.8%(5/132)。16.7%(22/132)接受了妊娠期心脏手术,其中77.3%(17/22)术后继续妊娠至34周后。(3)132例危重症先心病孕产妇的终止妊娠孕周为(30.5±8.6)周,主要方式为剖宫产术(71.2%,94/132)。101例(76.5%,101/132)危重症先心病孕产妇进入围产期(≥孕28周),其中,98例活产(97.0%,98/101),分娩活产儿99例(包括双胎1例)。99例活产儿中,早产儿59例(59.6%)、足月儿40例(40.4%);活产儿出生体重(2167±698)g。早产、胎儿生长受限、先天性畸形为胎儿的主要并发症。结论危重症先心病孕产妇主要来自经济、医疗水平欠发达地区;疾病干预晚,存在明确妊娠禁忌仍保留妊娠,致使母儿并发症发生率显著增加,医疗资源消耗增加。多学科团队联合积极救治,并在妊娠期行心脏手术可相对改善母儿结局。Objective To summarize the characteristics of pregnant women with critical congenital heart disease,and to explore continuous,integrated,multidisciplinary management for this segment of population.Methods The clinical records of pregnant women with severe congenital heart disease with a history of intensive care who were treated in Guangdong Provincial People's Hospital from January 1,2008 to December 31,2020 were retrospectively analyzed.Results(1)A total of 132 cases were included,including 128 pregnant women[gestational age(28.0±8.8)weeks]and 4 puerpera cases(6-32 days postpartum),63.6%(84/132)from economic underdeveloped rural areas,and 78.0%(103/132)by the municipal hospital,irregular prenatal examination accounted for 59.1%(78/132).The main type of congenital heart disease was shunt lesion(55.3%,73/132).90.9%(120/132)with mWHO risk classification stage Ⅳ were assigned to it.The main cardiovascular complication was pulmonary hypertension(64.4%,85/132).46.2%(61/132)of the patients had been diagnosed with congenital heart disease before pregnancy,and 70.5%(93/132)of the patients had not received any treatment before pregnancy.(2)All patients received obstetric-led,multidisciplinary care.The rescue success rate was 96.2%(127/132),and no serious obstetric complications occurred.The mortality within 24 hours after discharge was 3.8%(5/132).16.7%(22/132)underwent cardiac surgery during pregnancy,of which 77.3%(17/22)continued their pregnancy beyond 34 weeks.Totally,the delivery week was(30.5±8.6)weeks,and the main mode was cesarean section(71.2%,94/132).The average weight of 99 live births(including 1 twin pregnancy)was(2167±698)g.Preterm birth,fetal growth restriction,and congenital malformations were the main fetal comorbidities.Conclusions Pregnant women with severe congenital heart disease mainly come from areas with underdeveloped economic and medical levels.Later disease intervention,pregnancy retention despite of clear pregnancy contraindications are the distinctive features,which leaded to a significa

关 键 词：心脏缺损 先天性 妊娠 危重病人医疗 妊娠结局 

分 类 号：R714.252[医药卫生—妇产科学]