影响心脏瓣膜置换术术后妊娠结局的多因素分析

目的 研究多种因素对风湿性心脏病（风心病）换瓣术后妊娠结局的影响,并采取相应的干预措施改善妊娠结局.方法 选取本院2008年1月～2013年1月337例风心病换瓣术后妊娠患者,进行回顾性研究分析,并按多因素分组前瞻性研究.结果 （1）风心病换瓣术后心功能Ⅰ、Ⅱ级妇女妊娠结局明显优于Ⅲ、Ⅳ级妇女,差异有统计学意义（P 〈 0.05）.（2）心脏机械瓣膜置换术后妇女妊娠期间,单一服用较小剂量的华法林（〈5 mg/d）行抗凝治疗对孕妇安全、方便,且无胎儿畸形发生.（3）按严重高危妊娠规范产检组妊娠结局明显优于未规范产检组,差异有统计学意义（P 〈 0.05）.（4）计划分娩组妊娠结局明显优于急诊分娩组.结论 规范孕期监控及有效干预可明显改善风心病换瓣术后妊娠结局.

Multiple factors analysis of postoperative pregnancy outcome after cardiac valve replacement

Objective To study the effects of postoperative pregnancy outcome alter cardmc valve replacement, and to accept the corresponding intervention measures to improve the outcome of pregnancy. Methods Three hundred and thirty-seven cases of rheumatic heart valve replacement after pregnancy in our hospital from January 2008 to January 2013, were retrospectively analyzed and grouped by multiple factors, prospective study. Results （1）Cardiac function in I , II pregnancy outcome in rheumatic heart disease after valve replacement was significantly better than IlI, IV women, with significant difference （P 〈 0.05）. （2）Taking small doses of Hua Falin （〈5 rag/d） for single women with pregnancy after mechanical heart valve replacement underwent anticoagulant therapy for pregnant women was safety, convenience, and no fetal malformations occured. （3）According to the serious high-risk pregnancy standardized birth pregnancy outcomes were better than that without standardized birth group, the difference was statistically significant （P 〈 0.05）. （4）Planned delivery pregnancy outcomes were significantly better than emergency delivery group. Conclusion Pregnancy monitoring and effective intervention can significantly improve the outcome of pregnancy in patients with rheumatic heart disease after valve replacement.