围产期心功能不全59例临床分析

目的探讨围产期心功能不全的临床相关因素。方法对北京大学人民医院1990年1月至2008年12月间收治的59例围产期心功能不全患者的临床资料进行回顾性分析。结果①围产期心功能不全以妊娠高血压性心脏病发生率最高,22例（37.29%）,其次是风湿性心脏病10例（16.95%）,先天性心脏病9例（15.25%）等;②按心功能分级,Ⅱ级17例（28.81%）,Ⅲ级22例（37.29%）,Ⅳ级20例（33.90%）;③按心功能不全发生的时间：产前发生47例（79.66%）,产时2例（3.39%）,产后10例（16.95%）;④分娩方式：剖宫产44例（74.58%）,产钳5例（8.47%）,顺产10例（16.95%）;⑤孕产妇死亡1例,围产儿死亡率2例（33.9‰）。结论59例围产期心功能不全的病因以妊娠高血压性心脏病占首位,产前发生为主,分娩方式的选择以剖宫产为主。重视产时及产后心衰的预警。

Retrospective analysis of 59 cases of perinatal cardiac insufficiency

Objective To investigate the associated factors of perinatal cardiac insufficiency . Methods Fifty-nine cases of pregnant women with cardiac insufficiency Ⅱ to Ⅳ （NYHA standard） from January, 1990 to December , 2008 were analyzed retrospectively. Results ① Heart disease complicated with pregnancy induced hypertension was the first cause （22/59, 37.29%） of the cardiac insufficiency, rheumatic heart disease was the second one （10/59, 16.95%） and congenital heart disease was the third one （9/59, 15.25%）. （2） There were 17 cases （28.81%） with grade Ⅱ cardiac insufficiency, 22 cases （37.29%） with grade Ⅲ and 20 cases （33.90%） with grade Ⅳ, respectively. ③ There were 47 cases of cardiac insufficiency occurred prepartum （79.66%）, 2 cases during delivery （3.39%） and 10 cases postpartum （16.95%）. ④ Mode of delivery： 44 cases （74. 58%） delivered by cesarean section, 5 cases （8. 47%） by forcep delivery and 10 （16.95%） cases by vagnial delivery. ⑤ There was 1 case of perinatal infants death （33.9%） and 1 case of perinatal mother death. Conclusions Heart disease complicated with pregnancy induced hypertension are the chief cause of cardiac insufficiency. Cardiac insufficiency occurred most before labor. Cardiac insufficiency during delivery and postpartum deserve more care.