44例妊娠合并心脏病伴肺动脉高压患者的临床病例分析

Clinical analysis of 44 cases in pregnant women with pulmonary hypeternsion complicating cardiac disease

目的探讨妊娠合并心脏病伴肺动脉高压患者的妊娠结局及治疗。方法收集1998年1月～2008年1月,我院产科收治的44例妊娠合并心脏病伴肺动脉高压患者的临床资料(其中先天性心脏病23例,风湿性心脏病21例),根据肺动脉压力分为轻度组29例,中度组8例,重度组7例,分析各组心脏病种类、心功能级别、终止妊娠孕周和方式以及母儿结局。结果轻度组心功能Ⅰ～Ⅱ级者24例,中度组心功能Ⅱ～Ⅲ级的发病例数为6例,重度组心功能Ⅲ～Ⅳ级者7例;风湿性心脏病患者中,中、重度肺动脉高压者共有8例,占53%(8/15);先天性心脏病患者以轻、中度肺动脉高压者为主(87%,20/23);轻度组足月妊娠24例,中度组足月分娩1例,早产2例,医源性流产5例,重度组足月分娩1例,早产3例,医源性流产3例;妊娠合并心脏病伴肺动脉高压者的分娩方式以剖宫产分娩为主,占71%(31/44);孕产妇死亡率为7%(3/44),医源性胎儿丢失率为20%(9/44例)。结论随着肺动脉压力的升高,孕妇心功能衰竭的发生率随之增加,围产儿疾病发生率和胎儿丢失率也明显增加;妊娠合并风湿性心脏病患者中、重度肺动脉高压的发生率高于先天性心脏病患者;手术终止妊娠是比较安全的分娩方式。

ObjectiveTo evaluate the pregnancy outcome and treatment of women with pulmonary hypertension complicating cardiac disease. MethodsClinical data of 44 cases of pregnant women with pulmonary hypertension from Jan 1998 to Jan 2008 were analyzed and they were divided into three groups: 29 cases of slight group, 8 cases of moderate group and 7 cases of severe group. The types of heart disease, cardiac functional status (New York heart association, NYHA), gestational weeks of pregnancy termination, mode of delivery and outcomes of infants were compared between the groups. Results24 cases of NYHA class Ⅰ～Ⅱ were in slight group and 8 cases of NYHA class Ⅱ～Ⅲ were in moderate group and 7 cases of NYHA class Ⅲ～Ⅳ were in severe group; The rate of moderate and severe pul-monary hypertension was 53% (8/15) in rheumatic heart disease. The rate of slight and moderate pulmonary hypertension was 87% (20/23) in congenital heart disease; The rate of term delivery was 76% (22/29) in slight group. The rate of term delivery was 1/8, preterm labor 2/8, abortion 5/8 in moderate group. The rate of term delivery was 1/7, preterm la-bor occurred in 3 cases, and abortion in 3 cases in severe group; Caesarean section rate was 71% (31/44) among all patients; Overall maternal mortality was 7% (3/44).ConclusionsThe rate of heart failure, Perinatal morbidity and fetal loss gradually increase with the severity of pulmonary hypertension. The severity of pulmonary hypertension in rheumatic heart disease is higher than in congenital heart disease.Termination of pregnancy by surgery is a safe deliverymethod.