妊娠合并心脏病247例临床分析

目的 探讨妊娠合并心脏病,对母婴预后的影响.方法 收集我院2002年1月至2010年12月247例妊娠28周及以上且合并心脏病患者的临床资料并进行回顾性分析.结果 247例患者中,先天性心脏病138例,风湿性心脏病23例,妊娠期高血压疾病性心脏病8例,原发性心肌病7例,不明原因心律失常71例.心功能Ⅰ～Ⅱ级210例,心功能Ⅲ～Ⅳ级37例.与心功能Ⅲ～Ⅳ组比较,心功能Ⅰ～Ⅱ级组产检率、正常新生儿比例和新生儿体重较高84.3％ (177/210)比35.1％ (13/37),84.3％ (177/210)比29.7％( 11/37),(3012±568)g比(1894±658)g],差异均有统计学意义(均P＜0.01).而胎儿生长受限、早产、胎死宫内、新生儿窒息及新生儿先天性心脏病等发生率较低(分别为2.4％ (5/210)比27.0％ (10/37),P＜0.01；4.8％(10/210)比54.0％(20/37),P＜0.01;0比2.7％( 1/37),P＜0.05;0.5％( 1/210)比18.9％ (7/37),P ＜0.01；1.0％ (2/210)比8.1％ (3/37),P＜0.01).心功能Ⅲ～Ⅳ组孕产妇死亡1例.结论 妊娠合并心脏病严重危害母婴健康.孕前和孕期系统检查并进行相关处理,对于改善妊娠合并心脏病患者心功能和母婴预后具有重要意义.

Clinical analysis of 247 cases of pregnancy woman with heart disease

Objective To analyze clinical data of pregnant women with heart disease and explore its impact on maternal and infant prognosis. Methods Clinical data of 247 late pregnancy women with heart disease collected in our hospital from January 2002 to December 2010 were analyzed retrospectively. Results Of 247 pregnant cases with heart diseases, 138 cases had congenital heart disease, 23 cases had rheumatie heart disease, 8 eases had pregnancy-induced hypertension heart disease, 7 cases had primary cardiomyopathy, 71 cases had unidentified arrhythmia. Cardiac function grade Ⅰ～Ⅱ was in 210 cases, 37 eases had cardiac function grade Ⅲ～Ⅳ. Compared with those in cardiac function grade Ⅲ～Ⅳ group, detection rate, the proportion of normal newborns and neonatal weight in cardiac function grade Ⅰ～Ⅱ group were higher 84. 3% （177/210） vs 35. 1% （13/37） ,84. 3% （ 177/ 210） vs 29. 7% （11/37）, （3012±568）g vs （1894 ±658） g,all P〈0. 01], and the ineidenee rates of fetal growth restriction, premature birth, fetal death, neonatal asphyxia and neonatal congenital heart diseases in cardiac function grade I - II group were lower2. 4% （5/210） vs 27.0% （10/37） ,P 〈0. 01 ;4. 8% （10/210） vs 54. 0% （20/37）, P 〈0. 01 ;0 vs 2. 7% （1/37） ,P 〈0. 05 ;0. 5% （1/210） vs 18.9% （7/37） ,P 〈0. 01 ;1.0% （2/210） vs 8. 1% （3/ 37） ,P 〈 0. 01 ]. In cardiac function grade Ⅲ～Ⅳ group, 1 case had maternal mortality. Conclusions Pregnancy associated with heart disease damages the maternal and child health. Before and during pregnaney, system checks and treatment have an important significance of improving cardiac function and maternal and child prognosis.