妊娠合并心力衰竭的早期诊断与处理(附30例分析)

Early diagnosis and management of pregnancy with heart failure:report of 30 cases

目的探讨妊娠合并心力衰竭对母婴的危险性及诊断处理方法。方法回顾分析1998年1月-2005年12月我院收治的30例妊娠合并心力衰竭（简称心衰）患者的临床资料。结果妊娠合并心衰病例中子痫前期并发心衰占46.67%,围生期心肌病占13.33%,先天性心脏病占13.33%,风湿性心脏病占10%;平均心衰发生时间是孕（33±6）周,平均终止孕周时间为（35.2±2.7）周;早产发生率为71.43%,平均新生儿体重（2 389±710）g,围生期孕产妇死亡1例（3.33%）,围生儿死亡5例（17.85%）。误诊8例（26.67%）。结论妊娠合并心衰的主要病因为子痫前期。做好孕期宣教和产前检查,治疗以强心、利尿、扩张血管为主,结合病因制定个体化的治疗方案。剖宫产是比较安全的分娩方式。

Objective To study and discuss the fatalncss of heart failure to the mother and the neonate . Methods To analyse clinical data of 30 pregnant womcm with heart failure in our hospital from January 1998 to December 2005 rctrospcctivly. Resuits The rate of the heart failure in prccclampsia was 46.67%, pcripartum cardiomyopathy was 13.33%, congenital heart discase was 13.33% ,and rheumatic heart disease was 10%. Heart failure appeared at the average of （33±6）weeks, average terminal time of pregnancy was （35.2 ±2.7） weeks. The incidence rate of early birth was 71. 43%. The average weight of newborns was （2 389 ±710） g. The maternal mortality was 3.33 %, and the pcrinatal mortality was 17.85 % . The cases of misdiagnosis were 8. Conclusion The main cause of heart failure in pregnancy is preeclampsia. It is important to carry out health care of pregnant period and prenatal examination; the main management is using positively inotropic agents, diuretics, vasodilators. We should formulate individual program according to pathogcncsis. Ccasarcan section is more suitable for those women.