妊娠合并甲状腺功能亢进性心脏病临床分析

Clinical analysis on pregnancy combined with thyrotoxic heart disease

目的:探讨妊娠合并甲状腺功能亢进性心脏病(简称甲亢性心脏病)的发病因素、对妊娠结局的影响及诊断方法。方法:回顾性分析29例妊娠合并甲亢性心脏病患者的相关临床资料。结果:妊娠合并甲状腺功能亢进症(简称甲亢)发生率为0.82%,甲亢性心脏病发病约占甲亢的22.6%;29例甲亢性心脏病中,甲亢病情未控制稳定而妊娠者26例,占整组病例的89.7%;29例患者均发生了不同类型心律失常,而心脏器质性病变16例,占整组病例的55.2%;母体各类严重并发症13例,发生率为44.8%;死胎3例,28周前终止妊娠4例,早产10例,胎儿丢失率为24.1%,早产率为34.5%。结论:孕前或孕期甲亢病情的控制是决定孕期甲亢性心脏病发生的主要因素;妊娠期甲亢性心脏病可导致母儿多种严重并发症;孕期行甲状腺和心功能监测可及时诊断甲亢性心脏病,减少不良妊娠结局。

Objective：To explore the pathogenic factors,the effect on pregnancy outcome and diagnostic method of pregnancy combined with thyrotoxic heart disease.Methods：The related clinical data of 29 cases with pregnancy combined with thyrotoxic heart disease were analyzed retrospectively.Results：The incidence of pregnancy combined with hyperthyroidism was 0.82%,and combined complicated with thyrotoxic heart disease accounted for 22.6% of hyperthyroidism;among 29 cases with thyrotoxic heart disease,26 cases whose hyperthyroidism was not treated effectively or controlled well before getting pregnancy,accounting for 89.7% ;all the 29 cases suffered from different kinds of arrhythmia,and 16 cases were found with cardiac organic lesion,accounting for 55.2% ;13 cases suffered from different kinds of severe maternal complications,accounting for 44.8% ;intrauterine fetal death occurred in 3 cases,4 cases terminated pregnancy before 28 gestational weeks,preterm delivery occurred in 10 cases,the rate of fetal loss was 24.1%,and the rate of preterm delivery was 34.5%.Conclusion：Management of hyperthyroidism pre-or during pregnancy is the main factor of thyrotoxic heart disease during pregnancy;thyrotoxic heart disease during pregnancy may induce many kinds of severe maternal and fetal complications;thyroid and cardiac function monitoring during pregnancy can diagnose thyrotoxic heart disease timely,and reduce adverse pregnancy outcomes.