风湿性心脏病患者妊娠45例心功能状态与妊娠结局的关系

目的探讨风湿性心脏病孕妇的心功能状态与妊娠结局的关系。方法对2004年1月～2008年12月我院收治的45例风湿性心脏病孕妇的妊娠结局进行回顾性分析。结果妊娠合并风湿性心脏病者占妊娠合并心脏病病例的63．3％，以二尖瓣病变为主。心功能Ⅰ～Ⅱ级者多能维持妊娠到足月，平均孕周、新生儿窒息率好于心功能Ⅲ～Ⅳ级者（P〈0．05）。所有心功能Ⅲ～Ⅳ级和大多数心功能Ⅰ～Ⅱ级者均行剖官产终止妊娠。风心病患者心脏手术后能明显改善心功能。在心功能相同的情况下，无论孕妇有无心脏手术史，分娩孕周、新生儿体重、Apgar评分比较差异均无统计学意义（P〉0．05）。结论风湿性心脏病患者孕前手术矫治，积极改善心功能，孕期严密监护，心功能Ⅰ～Ⅱ级者能顺利度过妊娠期和分娩期，减少新生儿窒息率及死亡率，避免孕产妇死亡。

Relation of cardiac function of 45 pregnancies with rheumatic heart disease and outcome of pregnancy

Objective To investigate the relation of cardiac function of pregnant women with rheumatic heart disease and outcome of pregnancy. Methods Retrospective study was made on pregnant outcome of 45 pregnancies complicated by rheumatic heart disease. Results The percent of rheumatic heart disease complicating pregnancy to heart disease complicating pregnancy was 63.3% and the most of rheumatic heart disease complicating pregnancy was composed with mitral insufficiency. Subjects with cardiac function of degree Ⅰ - Ⅱmostly experienced term delivery. The average gestational age was longer, and the rate of neonatal asphyxia was lower in subjects with cardiac function of degree Ⅰ -Ⅱ than those of the patients with cardiac function of degree Ⅲ-Ⅳ （P〈0. 05）. Cesarean section was performed on all of the subjects with cardiac function of degree Ⅲ-Ⅳ and most of the subjects with cardiac function of degree Ⅰ - Ⅱ. The cardiac function of rheumatic heart disease was significantly improved after the cardiac operation. In case of the same cardiac function, no significant difference was found in the gestational age of delivery, the neonatal weight and Apgar score between pregnant women with operation and those without operation （P〉0. 05）. Conclusion If the patients with rheumatic heart disease having improved cardiac function of degree Ⅰ- Ⅱ after operation are strictly observed during pregnancy, they would successfully experience the period of pregnancy and delivery and the neonatal asphyxia and mortali.ty would be reduced and the death of pregnant and postpartum women would be avoided.