摘要
目的 分析妊娠合并结构性心脏病孕妇的临床诊治情况,探讨如何改善此类患者妊娠结局。方法 回顾性分析2019年1月至2021年6月于厦门大学附属第一医院住院分娩的88例妊娠合并结构性心脏病孕妇的临床资料,统计患者心脏病构成,收集患者年龄、孕产史、孕前是否行心脏手术、是否合并肺动脉高压以及母胎结局情况,根据患者是否孕前行心脏手术以及是否合并肺动脉高压将患者分别进行分组,探讨接受心脏手术后妊娠及其合并肺动脉高压对母胎结局的影响,同时分析分娩情况。结果 厦门大学附属第一医院孕妇最常见的结构性心脏病类型为先天性心脏病,共72例(81.82%),其次分别为风湿性心脏病8例(9.09%),围生期心肌病7例(7.95%),高血压性心脏病1例(1.14%)。孕前行心脏手术组的心功能Ⅲ~Ⅳ级、心功能加重<34周、肺动脉高压、产后并发症、转ICU的发生率低于未手术组,差异有统计学意义(P<0.05)。肺动脉高压组的心功能Ⅲ~Ⅳ级、心功能加重<34周、早产、转ICU的发生率高于肺动脉压正常组,差异有统计学意义(P<0.05)。88例患者中,65例(73.86%)经剖宫产分娩,23例(26.14%)经阴道分娩,无孕产妇死亡的发生。结论 孕前行心脏手术以及对合并肺动脉高压的孕妇加强监测及多学科联合管理诊治后,同时选择合适的方式终止妊娠,分娩期间采取合理的诊疗措施,可有效改善此类孕妇的预后。
Objective To analyze the clinical diagnosis and treatment of pregnant women with structural heart disease,and to explore how to improve the pregnancy outcomes of such patients.Methods The clinical data of 88 pregnant women with structural heart disease who delivered in the First Affiliated Hospital of Xiamen University from January 2019 to June 2021 were retrospectively analyzed.The composition of heart disease,age,pregnancy history,whether they had cardiac surgery before pregnancy,whether they had pulmonary hypertension and maternal and fetal outcomes were collected.The patients were divided into two groups according to whether they had cardiac surgery before pregnancy and whether they had pulmonary hypertension.The effects of pregnancy after cardiac surgery and pulmonary hypertension on maternal and fetal outcomes were analyzed,and the delivery situation was analyzed.Results The most common type of structural heart disease in pregnant women in the First Affiliated Hospital of Xiamen University was congenital heart disease(72 cases,81.82%),followed by rheumatic heart disease(8 cases,9.09%),peripartum cardiomyopathy(7 cases,7.95%),and hypertensive heart disease(1 case,1.14%).The incidences of gradeⅢ-Ⅳcardiac function,aggravated cardiac function<34 weeks,pulmonary hypertension,postpartum complications,and transfer to ICU in the pre-pregnancy cardiac surgery group was lower than that in the non-surgery group,and the differences were statistically significant(P<0.05).The incidences of gradeⅢ-Ⅳcardiac function,aggravated cardiac function<34 weeks,preterm birth and transfer to ICU in the pulmonary hypertension group were higher than those in the normal pulmonary artery pressure group,and the differences were statistically significant(P<0.05).Among the 88 patients,65 cases(73.86%)were delivered by cesarean section,23 cases(26.14%)were delivered by vaginal delivery,and no maternal death occurred.Conclusion Cardiac surgery before pregnancy,strengthened monitoring and multidisciplinary management of pregnant women with pulmonary hypertension,appropriate termination of pregnancy,and reasonable diagnosis and treatment during delivery can effectively improve the prognosis of such pregnant women.
作者
苏炳峰
陈国庆
吴忠祥
陈宝花
周颖
SU Bingfeng;CHEN Guoqing;WU Zhongxiang;CHEN Baohua;ZHOU Ying(Department of Obstetrics and Gynecology,the First Affiliated Hospital of Xiamen University,Fujian Clinical Research Center for Gynecologic and Reproductive Health,Fujian Branch of National Clinical Medical Research Center for Obstetrics and Gynecology Diseases,Key Laboratory of Research and Diagnosis of Gynecological Diseases of Xiamen City,Fujian Province,Xiamen 361000,China)
出处
《中国当代医药》
2025年第19期63-67,共5页
China Modern Medicine
基金
福建省厦门市卫生健康高质量发展科技计划项目(2024GZL-QN084)
关键词
妊娠
结构性心脏病
心脏手术
肺动脉高压
妊娠结局
Pregnancy
Structural heart disease
Cardiac surgery
Pulmonary hypertension
Pregnancy outcome
