妊娠合并心脏病296例临床分析

Clinical analysis on 296 cases of pregnancy with heart disease

目的:探讨妊娠合并器质性心脏病患者母儿预后的影响因素。方法:对我院1995年1月～2005年12月间296例妊娠合并器质性心脏病患者的有关临床资料进行回顾分析。结果:妊娠合并器质性心脏病的发病率为2.31%。孕前已行心脏手术纠正者心功能I～II级占95.50%。心脏病的种类对产妇及新生儿预后无显著影响。心功能Ⅲ～Ⅳ级者,其早产儿、新生儿低体重和围产儿死亡等发生率明显增加。孕前未行外科手术者,其妊娠合并症明显高于已行手术者,早产儿及胎儿生长受限发生率亦明显高于后者。结论:妊娠合并先天性心脏病最常见,风湿性和先天性心脏病是导致孕产妇严重心功能不良的主要病因,母亲心功能状态直接影响围产儿质量。孕前积极治疗或行心脏手术能明显改善心功能,使妊娠有良好结局。剖宫产是终止妊娠的最佳方式。

Objective： To investigate the influential factors of maternal - fetal outcomes in pregnant women complicated with organic heart diseases. Methods： Clinical data of 296 pregnant cases with either rheumatic or congenital heart diseases, collected from Beijing Anzhen Hospital during Jan 1995 - Dec 2006, were analysed retrospectively. Results： The prevalence of organic heart diseases in total pregnant women during the same period was 2. 31%. The rate of grade Ⅰ-Ⅱ heart function in pregnant women after heart operations was 95. 5%. No significant difference was found in maternal- fetal complications between the two types of heart diseases. However, the incidences of maternal heart failure, premature birth, intrauterine growth retardation were significantly higher in patients without previous surgical treatment as compared with those with previous surgical therapy, and were also higher in patients with heart function of grade Ⅲ-Ⅳ in comparison with those with grade Ⅰ-Ⅱ. Conclusion： Patients with organic heart diseases should be treated and operated on in order. Pregnancies complicated with congenital and rheumatic heart diseases are still major causes of per natal morbidity and mortality of mother and baby. For improving the heart function, more effective managements or heart operation should be adopted before pregnancy. Cesarean section is the better choice of delivery.