妊娠期心脏病心力衰竭的处理和分娩时机的探讨

Management of heart failure and timing of delivery in pregnancy

目的:探讨妊娠合并心力衰竭(心衰)的孕期处理、分娩时机的选择及其对母婴预后的影响。方法:回顾性分析356例妊娠期心脏病患者的发病情况,心衰的发生率、治疗效果,分娩方式与时机等资料。结果:356例妊娠期心脏病中有136例(38.20%)发生心衰,其中中重度心衰76例(55.88%);风湿性心脏病(风心病)较先天性心脏病(先心病)易发生心衰;孕前未行心脏手术治疗的风心病患者较先心病易发生心衰,孕前已行心脏手术治疗的风心病孕妇中重度心衰发生率明显较孕前未行手术治疗者下降(P<0.05);孕期心衰控制良好组与不良组比较,前者对妊娠、分娩的耐受性好,能顺利度过妊娠、分娩、产褥期。结论:风心病和先心病是妊娠期心力衰竭的主要原因,孕前特别是风心病患者行心脏手术治疗,可显著改善妊娠期心功能,妊娠期密切监视心功能,妊娠晚期控制心衰后及时终止妊娠。有利于孕妇和围产儿的预后。

Objective To explore the management of heart failure, the timing of delivery in pregnancy, and the influencce on pregnant prognosis. Methods We retrospectively analyzed the incidence of heart failure, treatment results, pattern of termination, and time of termination in 356 cases of pregnancy with heart disease. Results One hundred and thirty-six （38.20%） cases were diagnosed as heart failure and 76 （55.88%） were moderate or severe heart failure. Heart failure tends to occur more easily in rheumatic heart diseases than in congenital heart diseases. Heart failure occurred more frequently in pregnancy with rheumatic heart diseases without the heart operation before pregnancy than that of pregnancy with congenital heart diseases. The occurence of the moderate and severe heart failure in pregnancy decreased in rheumatic heart diseases with surgical therapies compared with those without surgical therapies （P 〈 0.05）. Compared with pregnancy with heart failure controlled inadequately, pregnancy with effectively controlled heart failure had better tolerance during delivery and through the pregnancy, and puerperium. Conclusion Congenital heart diseases and rheumatic heart diseases are the chief causes of heart failure during the gestation. Therapy before pregnancy, especially surgery to the rheumatic heart diseases, may improve the cardiac function during pregnancy. Monitoring heart function and selecting the proper timing to terminate pregnancy after controlling the heart failure in late pregnant period will be helpful to improve the prognosis of pregnant and perineonate.