子前期并发心衰38例临床分析

Analysis of the etiology and the management of heart failure complicating severe preeclampsia

目的探讨子疒间前期并发心衰发生的诱因、治疗要点及预防措施。方法上海第二医科大学附属仁济医院产科心脏病监护中心,于1993年5月至2005年5月间共诊治重度子疒间前期患者105例,其中38例并发心衰(A组),67例未发生心衰(B组),对两组患者的临床资料进行回顾性分析。结果重度子疒间前期并发心衰的发生率为36.19%。A组有5例患者(15.64%)、B组有48例患者(71.64%)接受过常规产前检查,两组比较差异有显著性意义(P<0.01);A组患者的收缩压、舒张压和心率均显著高于B组,平均终止妊娠孕周则显著低于B组;左心室后负荷急剧增加是重度子疒间前期心衰发生的主要原因。心脏前负荷短期快速增加、贫血和肺部感染是诱发心衰的常见因素。结论做好常规产前检查,迅速控制重度子疒间前期患者的血压是防治心衰的关键;硫酸镁可安全有效地治疗子疒间前期心衰,但应掌握使用的时机和方法。

Objective To analyse the inducement , management and prophylaxis of heart failure complicating severe preeclampsia. Methods There were 105 cases of severe preeclampsia in Renji Hospital, Shanghai Second Medical University from May 1993 to May 2005. Among them, 38 cases were complicated with heart failure（group A） and 67 cases were not（group B） . Their clinical course were compared. Results The rate of heart failure complicating severe preeclampsia was 36. 19%. As regard to receiving prenatal examination, there were 5 cases（ 15.64% ）in group A, and 48 cases （ 71.64% ） in group B. There were significant differences between two groups（ P 〈0. 01 ）. The systolic pressure and diastolic pressure ,and heart rate in group A were significantly higher than those in group B. The increased after-load of heart was the main cause for heart failure complicating severe preeclampsia. The other induced factors included increased before-load of heart, anemia and infection of respiratory tract. Conclusion Routinely carrying out prenatal examination and rapidly reducing blood pressure are very important for prevention of heart failure complicating severe preeclampsia. Magnesium sulphate could be used safely and effectively for treatment of heart failure complicating severe preeclanpsia.