心功能对妊娠合并心脏病的影响

目的探讨妊娠合并心脏病的不同心功能级别对妊娠结局的影响及产科防治措施。方法分析2006年10月至2010年10月住院的245例妊娠合并心脏病产妇的病历资料。结果（1）心律失常在妊娠合并心脏病的发生率最高占44．46％，以窦性心律失常为主，心功能表现为Ⅰ-Ⅱ级。（2）心功能Ⅲ-Ⅳ级以妊娠合并高血压疾病性心脏病（40．91％）、围生期心肌病（15．91％）和风湿性心脏病（15．91％）为主（P〈0．01）。（3）63．64％的Ⅲ～Ⅳ级患者合并产科情况，其中子痫和低蛋白血症的发生率较高（P〈0．01）。（4）心功能Ⅱ级组剖宫产率高于Ⅰ级组（P〈0．05），与Ⅲ～Ⅳ级组比较差异无统计学意义（P〉0．05），以心脏因素为指征的剖宫产率，I级组低于Ⅱ级和Ⅲ-Ⅳ级组（P〈0．01），1I级和Ⅲ一Ⅳ级组差异无统计学意义（P〉0．05）。（5）Ⅲ～Ⅳ级组医源性早产和小于胎龄儿发生率高于Ⅰ～Ⅱ级组（P〈0．05）。结论妊娠合并心脏病患者分娩时机和方式主要取决于心功能储备和产科情况。心功能越差，胎儿不良结局的发生率越高。早期筛查和治疗妊娠高血压疾病是防止妊娠特发性心脏病发生的关键。

Effect of different cardiac functional grades on the outcome of pregnancy complicated by heart diseases

Objective To investigate the effect of different cardiac functional grades on the outcome of pregnancy complieated by heart diseases,and to explore the preventive and therapeutic measures. Methods The clinical data of 245 pregnant women complicated by heart diseases were collected between January 2007 and August 2008,which were retrospectively analyzed. Results The incidence of arrhythmia was highest in the women with pregnancy complicated by heart diseases, which accounted for 44. 46%, with main sinus arrhythmia and cardiac function at grade I and II. The women with cardiac function al grade Ⅲ-Ⅳ suffered from mainly pregnancy complicated by hypertensive heart disease （40.91%）, peripartum eardiomyopathy （15.91%） and rheumatic heart diseases （ 15.91 % ） （ P 〈 0.01 ）. The proportion of eelampsia and hypoproteinemla was highest m patients with cardiac function at grade Ⅲ and Ⅳ, which accounted for 63.64%. The cesarean section rate m patients with cardiac function at grade I1 was significantly higher than that of grade Ⅰ （ P 〈 0.05 ）, however, there was no significant difference between grade Ⅱgroup and grade Ⅲ, grade Ⅳ group （ P 〉 0.05 ） , The cesarean section rate in patients with cardiac function at grade I was obviously lower than that at grade Ⅲ - Ⅳ（P 〈 0.01 ）, but there was no significant difference between grade Ⅱ group and grade Ⅲ- Ⅳ groups （ P 〉 0.05）. The incidences of iatrogenic premature delivery and SGA in grade Ⅲ -Ⅳ groups were significantly higher than those of grade Ⅰ - Ⅱ groups （ P 〈 0.05）. Conclusion The selection of delivery modes and occasion in the women with pregnancy complicated by heart diseases depends mainly on pregnant women＇ s heart function and obstetrical conditions. The poorer heart function, the higher incidence of bad outcome of fetus, so the early detection and treatment for gestational hypertension is the key to prevent occurrence of gestational heart diseases.