455例妊娠合并心脏病患者不同心功能状况对妊娠结局的影响

目的探讨妊娠合并心脏病不同心脏功能对妊娠结局的影响。方法对北京大学第三医院1994年1月至2008年12月间妊娠合并心脏病455例患者的临床资料进行回顾性分析。结果妊娠合并心脏病以心律失常（223例,49.01%）和先天性心脏病（140例,30.77%）最为常见,风湿性心脏病居第三位（33例,7.25%）。妊娠合并心律失常患者心功能均为Ⅰ～Ⅱ级,妊娠合并先天性心脏病患者心功能为Ⅰ～Ⅱ级者为135例,Ⅲ～Ⅳ级为5例,其中1例为为妊娠合并艾森曼格综合征,产后7 d猝死;妊娠期高血压性心脏病17例心功能Ⅲ～Ⅳ级,其中1例孕妇死亡;围生期心肌病5例,其心功能均为Ⅳ级。心脏功能Ⅲ～Ⅳ级患者的妊娠孕周明显小于心功能Ⅰ～Ⅱ级（P〈0.05）,医源性早产和围产儿死亡率显著增加（P〈0.01）。结论心脏功能Ⅲ～Ⅳ级患者以妊娠期高血压性心脏病、先天性心脏病和围生期心肌病多见,其医源性早产、孕产妇及围产儿死亡的发生增加。妊娠合并心脏病患者的心脏功能状态与其孕产妇及围产儿结局密切相关。

Outcome of pregnancy complicated with cardiac disease:a review of 455 patients

Objective Objective To investigate the effect of different cardiac function of pregnancy complicated with cardiac disease on the outcome of pregnant women and newborn.Methods Clinical data of 455 pregnant patients complicated with cardiac disease were reviewed.Results The most common cardiac disease during pregnancy was arrhythmias with the NYHA grading Ⅰ-Ⅱ（49.01%）,followed were congenital heart disease and rheumatic heart disease,with a frequency of 30.77% and 7.25%,respectively.Five of the congenital heart disease were of grade Ⅲ~Ⅳ,and one mother with Eisenmenger syndrome died one week postpartum with irreversible hypoxia.Seventeen patients developed heart failure complicated with preeclampsia-eclampsia,one of them died after cesarean section.The average neonate body weight of the patients with NYHA grading Ⅰ-Ⅱ was significantly higher than that of the patients with NYHA grading Ⅲ and Ⅳ（P0.05）.The incidence of perinatal mortality and medical preterm delivery were higher in women with Grading Ⅲ~Ⅳ than in those with Grading Ⅰ~Ⅱ（P0.01）.Conclusions The chief causes of NYHA grading Ⅲ~Ⅳ during pregnancy were preeclampsia-eclampsia with heart failure,congenital heart disease and peripartum cardiomyopathy,which resulted in the increasing of medical preterm delivery,maternal and preinatal mortality.