预激综合征患者围产期室上性心动过速发作及对妊娠结局的影响

Outcome of pregnancy complicated with preexcitation syndromes:a review of 38 patients

目的探讨妊娠合并预激综合征围产期室上性心动过速发作特点及对妊娠结局的影响。方法对北京大学第三医院1993年1月至2009年6月间妊娠合并预激综合征38例住院分娩患者的临床资料进行回顾性分析。结果妊娠合并预激综合征患者围产期发作室上性心动过速(SVT)5例,占13.16%(5/38),共发作SVT29次;在妊娠28～36周末(51.72%,15/29)及妊娠13～27周末(34.48%,10/29)发作所占的比例最高。妊娠期SVT发作增加者占10.53%(4/38)。妊娠前确诊预激综合征且合并SVT(未治疗)7例患者中4例在妊娠期没有发作SVT。围产期出现的29次室上性心动过速发作中,7次(24.14%)通过刺激迷走反射、18次(62.07%)经药物治疗好转,4次(13.79%)发作行经食管心脏调搏心律恢复正常。预激综合征患者围产期室上性心动过速发作与未发作组相比,平均分娩孕周、新生儿出生体重及分娩方式差异均无统计学意义(P>0.05)。结论预激综合征患者少部分围产期室上性心动过速发作增加,可能与妊娠期血容量的快速增加有关;规范合理的治疗可以有效地控制妊娠期室上性心动过速发作,妊娠结局良好。

Objective To investigate the influence of preexcitation syndromes on the outcome of pregnancy.Methods Clinical data of 38 pregnant women complicated with preexcitation syndromes who delivered in Peking University Third Hospital form January 1993 to June 2009 was reviewed.Results The incidence of supraventricular tachycardia（SVT） in pregnant women with preexcitation syndromes was 13.16%（5/38）.The most common period at which the episode of SVT occurred was 28 week to 36 week（51.72%,15/29） and the midtrimester（34.48%,10/29）. The incidence of pregnancy-induced increasing of supraventricular arrhythmias in preexcitation syndromes was 10.53%（4/38）. Four of seven women who had prior history of SVT with preexcitation syndromes had no episodes of SVT during pregnancy.There were twenty-nine attacks of SVT during pregnancy in five patients, in which 24.14%（7/29） were successfully treated with parasympathetic maneuvers, 62.07%（18/29） were terminated by verapamil or propafenoe and 13.79%（4/29） by transesophageal cardiac pacing. There was no difference in average delivery week, birth weight and delivery method between pregnant women with preexcitation syndrome with or without SVT.Conclusions Only minority of women complicated with preexcitation syndrome experienced pregnancy-induced increasing supraventricular arrythmias which maybe related to the rapid increasing of plasma volume during pregnancy.The outcome of preexcitation syndromes during pregnancy are optimal in most patients with standard medical therapy.