4种不同病因导致的54例妊娠期心力衰竭与妊娠结局的分析

目的:了解妊娠合并心衰对母儿的危害,探讨妊娠合并心衰四种不同发病原因与妊娠结局的关系。方法:回顾性分析2004年12月～2007年9月广州市重症孕产妇救治中心收治的54例妊娠期心力衰竭患者,对其发病原因及妊娠结局进行分析。结果:妊娠期高血压疾病性心脏病发生心衰者34例(62.96%),妊娠合并风湿性心脏病8例(14.81%),围产期心肌病7例(12.96%),妊娠合并甲亢性心脏病5例(9.25%)。其终止妊娠的时间分别是(33.26±2.66)周、(32.46±5.97)周、(37.22±4.88)周、(36.34±4.67)周。孕产妇死亡2例(3.70%),新生儿死亡9例(16.66%)。结论:妊娠合并心力衰竭的病因中以妊娠期高血压疾病最为常见;妊娠合并风湿性心脏病的产妇以及胎儿的预后最差,早产率高;围生期心肌病以及甲亢性心脏病如果控制及时,新生儿的预后较好。所以明确妊娠合并心力衰竭的原因,对及时正确处理妊娠合并心力衰竭,有利于降低围产期孕产妇和围产儿的死亡率。

Analysis on outcomes of heart failure during pregnancy and pregnant outcomes in 54 cases induced by 4 kinds of causes

Objective:To understand the dangers of heart failure during pregnancy to mothers and neonates,explore the relationship between 4 kinds of causes and pregnant outcomes in cases with heart failure during pregnancy.Methods:54 cases with heart failure during pregnancy from November 2004 to September 2007 were analyzed retrospectively,the causes and pregnant outcomes were analyzed.Results:The incidences of heart failure induced by hypertensive disorder complicating pregnancy(HDCP),rheumatic heart disease,peripartum cardiomyopathy,hyperthyroid heart disease combined with pregnancy were 62.96%(34 cases),14.81%(8 cases),12.96%(7 cases) and 9.25%(5 cases),respectively,and the average terminal times of pregnancy were(33.26±2.66) weeks,(32.46±5.97) weeks,(37.22±4.88) weeks and(36.34±4.67) weeks,respectively;the numbers of maternal death and neonatal death were 2 cases(3.70%) and 9 cases(16.66%),respectively.Conclusion:The main cause of heart failure during pregnancy is HDCP;the prognosis of mothers and neonates in pregnant women with rheumatic heart disease is the worst,and their premature birth rate is the highest;the prognosis of neonates is good based on timely control of peripartum cardiomyopathy and hyperthyroid heart disease;clear causes and correct treatment of heart failure during pregnancy are helpful to reduce the maternal and perinatal mortality.