围生期心肌病发病相关因素的研究

目的 探讨围生期心肌病(PPCM)发病的相关因素.方法 时82例PPCM患者进行流行病学调查,检查心脏彩超,测定肌钙蛋白I(cTNI)、高敏C-反应蛋白(hs-CRP)、N末端B型利钠肽(NT-proBNP)等指标,并随机对其中52例患者进行了平均6个月的随访.对照组选用同期住院的正常分娩患者.结果 PPCM患者与对照组相比,年龄较大[分别为(29.5±6.4)岁和(25.2±5.8)岁,P<0.01],血压较高(分别为146.9/98.8 mm Hg和130.2/80.1 mm Hg,P<0.01),剖宫产比例较高(分别为65.9%和51.0%,P<0.05),合并感染率明显升高(分别为75.6%和10.0%,P<0.01),实验室检查白细胞(分别为11.0×109/L和8.8×109/L,P<0.01)、cTNI(分男q为0.17μg/L和0.06μg/L,P<0.01)、hs-CRP(分别为2 8.2ms/L和6.2 mg/L,P<0.01)、NT-proBNP(分别为650.1 ng/L和110.5 ns/L,P<0.01)明显升高,hs-CRP和NT-proBNP呈正相关(r=0.67,P<0.01).经过平均6个月的治疗,平均射血分数由32.2%提高至50.6%,NT-proBNP明显下降(治疗前、后分别为650.1 ng/L和225.6 ng/L,P<0.01),NT-proBNP下降的独立影响因素为舒张压下降(P<0.05)、左心室舒张末径缩小(P<0.05)和hs-CRP下降(P<0.05).结论 炎症反应在围生期心肌病发病中起了重要的作用.     

围生期心肌病发病相关因素的研究

Objective To explore the risk factors of peripartum cardiomyopathy (PPCM). Methods A total of 82 PPCM and 100 normal delivery females were randomly recruited in the current study. Echocardiographic, cTNI,high sensitive C-reaction protein(hs-CRP) ,NT-proBNP were measured. Fifty-two patients were followed up for a mean of 6 months. Results The PPCM patients (29. 5 ± 6. 4) yrs were older than the controls (25. 2 ± 5. 8) yrs (P<0.01) . Compared to the controls, the PPCM patients showed higher blood pressure (146.9/98. 8 mm Hg v. s. 130. 2/80. 1 mm Hg, P < 0. 01) , higher proportion of cesarean section (65. 9% v. s. 51. 0% , P < 0. 05) and complicated infection(75. 6% v. s. 10. 0% ,P <0. 01). The level of leucocyte(11.0 × 109/L) ,cTNI(0. 17 μg/L), hs-CRP(28. 2 mg/L)and NT-proBNP(650. 1 ng/L) were significantly higher in the PPCM patients compared with control(8. 8 × 109/L,0. 06μg/L,6. 2 mg/L and 110. 5 ng/L,P <0. 01). Hs-CRP was positively related with NT-proBNP(r = 0. 67, P < 0. 01). After average of 6 months of treatment, left ventricular ejection fraction enhanced from 32. 2% to 50. 6%. NT-proBNP significantly declined from 650. 1 ng/L to 225.6 ng/L(P <0. 01). Multiple linear regression analysis showed that diastolic pressure (P < 0. 05), LVED (P < 0. 05) and hs-CRP (P < 0. 05) were the independent predictors for declined NT-proBNP. Conclusions Inflammatory plays an important role in the development of peripartum cardiomyopathy.     

围生期心肌病流行病学及护理研究现状

作者综述了围生期心肌病的流行现状以及相关因素,总结了围生期心肌病病人护理,以便提高孕产妇及胎儿的生命质量。     

围生期心肌病46例临床分析

围生期心肌病(peripartumcardiomyopathy,PPCM)是指原无心血管系统疾病史的孕产妇,于妊娠最后3个月或产后6个月内首次发生的、以累及心肌为主的一种心脏病。临床上主要表现为充血性心力衰竭。现将1987年以来收治的46例分析如下。1　临床资料1.1　一般资料　本组46例,年龄20～38岁,平均27.2岁。农民39例(占84.8%),工人6例,干部1例。初产妇30例(占65.2%),经产妇16例。产前发病6例,产后发病40例,产后3个月内发病37例(占80.4%)。首次发病44例,再次妊娠后复发2例。所有患者均无心血管系统疾病史。1.2　临床表现　46例均有心悸、呼吸困难、心界…     

β受体阻滞剂治疗围生期心肌病的临床研究

目的了解β受体阻滞剂治疗围生期心肌病的临床效果。方法将符合诊断标准的25例住院的围生期心肌病患者采取随机、对照的原则分为两组。常规组10例给予地高辛0．125～0．250mg／d，间断使用双氢克尿噻25mg，1～3次／d；安体舒通20mg，1次／d；扩血管药物卡托普利12．5mg，1、2次／d。实验组15例在对照组用药基础上加β受体阻滞剂（美托洛尔，卡维地洛或比索洛尔），关托洛尔开始剂量6．25mg，1次／d；或卡维地洛6．25mg，1次／d；适应后加量至12．5mg，1、2次／d，或比索洛尔2．5mg，1次／d，维持4周。在治疗前后分别测量两组的皇心室射血分数（LVEF）、心功能并统计住院时间，对两组的LVEF变化值、心功能改善程度和住院时间进行比较。结果两组患者的年龄及治疗前心功能、LVEF无明显差异（P〉0．05）；治疗后实验组LVEF明显改善（P〈0．05），心功能改善（P〈0．05），住院时间缩短（P〈0．05）。结论β受体阻滞剂治疗围生期心肌病是安全的，可提高LVEF，有效改善心功能、缩短住院时间、提高生活质量。     

围生期心肌病四例误诊原因分析

围生期心肌病 (PPCM)是指原无器质性心脏病 ,孕妇于妊娠最后 3个月到产后 6个月内出现的心脏扩大和充血性心力衰竭的一种心脏病[1] 。本病在临床上并非少见 ,但由于对此缺乏充分认识 ,易造成误诊误治。我院 2 0 0 0年 1月～ 2 0 0 2年 2月收治围生期心肌病 9例 ,其中误诊 4例 ,误诊率 4 4%。现分析报告如下。1　临床资料1 1　一般资料　本文 4例均为育龄妇女 ,年龄 2 4～ 4 2岁 ,经产妇 3例 ,初产妇 1例。产前 1～ 3个月发病。1 2　临床表现　呼吸 2 2～ 2 8/min ,脉搏 114～ 12 0 /min ,呼吸困难 3例 ,均有口唇发绀与颈静脉怒张 ,下肢水…     

围生期心肌病的临床治疗分析

目的总结围生期心肌病的临床治疗方法及效果。方法随机选取2013年1月至2016年1月我院接收的围生期心肌病患者40例,给予患者X线、超声心动图、心电图检查及综合性治疗,分析其临床治疗效果。结果治疗后,40例患者中治愈30例,好转8例,无效1例,死亡1例,总有效率为95.0%;治疗后患者的心功能明显改善,与治疗前比较,差异具有统计学意义(P<0.05)。结论对围生期心肌病患者进行综合性治疗,适时终止妊娠,能够改善患者的心功能,提升临床治疗效果,降低死亡率。     

围生期心肌病合并心力衰竭20例治疗体会

目的:探讨围生期心肌痛心力衰竭的治疗方法.方法:回顾性分析20例围生期心肌病并心力衰竭患者的临床资料.结果:治愈19例,产妇及胎儿均死亡1例,产妇存活、新生儿死亡2例.结论:围生期心肌痛心力衰竭患者应及时行剖宫产终止妊娠,给予扩血管、利屎基础治疗,并适当强心.     

围生期心肌病的诊断与治疗(附36例报告)

围生期心肌病 (peripartum cardiom yopathy,PPCM)是指在妊娠过程中 (多在最后 3个月 )或产后 6个月内 ,首次发生以累及心肌为主的一种心脏病。该病早期缺乏特征性临床表现 ,易误诊、漏诊。 1992年 1月～ 1998年 1月 ,我院收治PPCM36例 ,报告如下。1　临床资料1.1　一般资料　本组 36例 ,年龄 2 2～ 46岁 ,平均 32 .2岁。第一胎妊娠 6例 ,多次妊娠 30例。有妊娠高血压综合征 (妊高征 ,PIH) 2 3例 ,肥胖 17例 ,中度贫血 2 5例。妊娠最后 3个月发病 2 7例 ,产褥期发病 9例。1.2　临床表现　咳嗽 36例 ,呼吸困难 2 8例 ,端坐呼吸 17例 ,双…     

A review of peripartum cardiomyopathy

Peripartum cardiomyopathy is a rare form of cardiomyopathy, of unknown aetiology, which is associated with a significant morbidity and mortality. It is characterised by the presentation of heart failure, within a month of delivery and up to 5 months post-partum, secondary to left ventricular impairment. It is essentially a diagnosis of exclusion and can only be made in the absence of any other demonstrable cause. One of the most challenging areas is in pre-natal counselling, when a woman wishes to undertake a further pregnancy, because recovery of left ventricular function gives no guarantee of safety.     

Improving outcomes in peripartum cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a rare condition with a diverse spectrum of potential outcomes, ranging from frequent complete recovery to fulminant heart failure and death. The pathogenesis of PPCM is not well understood, and relatively little is known about its incidence and prevalence. PPCM is often under-recognised in the clinical setting. Early investigation and diagnosis with subsequent expert management may improve outcomes. The development of registries will allow this condition to be better characterised and may help answer crucial questions regarding its optimal medical and surgical management. This paper reviews the potential approaches to improve outcomes in patients with PPCM.     

An update on peripartum cardiomyopathy

Peripartum cardiomyopathy is a rare but potentially devastating complication of pregnancy. Although the definition of this condition has recently been revised by the Heart Failure Association of the European Society of Cardiology, the pathogenesis of peripartum cardiomyopathy is not well understood and relatively little is known about its incidence and prevalence. Hence, peripartum cardiomyopathy is often under-recognized in the clinical setting. A heightened awareness of this condition and its current management options is therefore warranted throughout primary and secondary care. The identification of the putative role of prolactin in the development and progression of this condition has been recently discovered, with preclinical work suggesting beneficial effects of prolactin antagonism. In this article, we review the literature regarding this condition including these recent advances.     

Case of fulminant hepatic failure due to unrecognized peripartum cardiomyopathy

OBJECTIVE: To describe a postpartum patient who presented with fulminant hepatic failure and hepatic coma as a result of unrecognized peripartum cardiomyopathy. DESIGN: Case report. SETTING: Medical intensive care unit of a tertiary care academic medical center. PATIENT: A 35-yr-old woman 5 wks postpartum from an uneventful spontaneous vaginal delivery who was transferred to our institution with fulminant hepatic failure and worsening hepatic encephalopathy of unknown etiology for consideration of liver transplantation. INTERVENTIONS: An echocardiogram was obtained as part of an evaluation for refractory shock and the patient was found to have severe global hypokinesis with an ejection fraction of approximately 15%. She was diagnosed with peripartum cardiomyopathy and treatment with digoxin and afterload reduction was initiated. MEASUREMENTS AND MAIN RESULTS: After initiation of appropriate treatment for dilated cardiomyopathy, the patient's hepatic failure resolved and she made a full recovery. CONCLUSIONS: Congestive heart failure is one of the few treatable causes of fulminant hepatic failure. Congestive heart failure must always be included in the differential diagnosis of fulminant hepatic failure of unknown pathogenesis.     

ED echocardiography for peripartum cardiomyopathy.

Although peripartum cardiomyopathy is uncommon, emergency physicians should be knowledgeable of it because of its high morbidity and mortality. Emergency physicians should be alert to the fact that the clinical presentation of peripartum cardiomyopathy is nonspecific. Its clinical manifestations are found in other medical conditions that can present in the late prepartum or postpartum patient. We present a case of peripartum cardiomyopathy that illustrates how its nonspecific respiratory signs and symptoms led to an initial diagnosis of pulmonary embolism. The case also highlights the need for echocardiography in the evaluation of peripartum cardiomyopathy. We discuss the clinical presentation, diagnosis, and treatment of peripartum cardiomyopathy.