妊娠合并心脏病176例分析

ANALYSIS OF PREGNANCY COMPLICATED WITH HEART DISEASE FOR 176 CASES

目的：探讨妊娠合并心脏病患者围产期心衰的处理方法和分娩方式。方法：对１９８９ ～１９９８ 年收住院的１７６ 例妊娠合并心脏病患者的临床资料进行回顾分析。结果：妊娠合并心脏病的发生率为１ ．５ ％ ，心脏疾病构成比中，以风心病居首位，先心病、心肌炎、妊高征心脏病分别居第二、三、四位。本组心功能Ⅱ～Ⅳ级者９２ 例（５２ ．３ ％ ） ，其中左心衰５６ 例，右心衰７ 例，全心衰２９ 例。心衰发生于３２ ～３６ 孕周者６５ 例（７０ ．７ ％ ） ，发生于３６ 孕周以后者２０ 例（２１ ．７ ％ ） 。产程中发生急性肺水肿者７ 例，均为风心病、 Ｍ Ｓ 合并 Ａｆ 患者。剖宫产１０８ 例（６１ ．４ ％ ） ，其中心功能Ⅰ～Ⅱ级者７７ 例，Ⅲ～Ⅳ者３１ 例。新生儿死亡３ 例，均系宫内缺氧所致。产妇死亡３ 例，其中２ 例死于产后急性肺水肿，１ 例死于产后心室颤动。结论：要加强对早期心衰的防治，把好３２ ～３６孕周、第二产程、产后“三大关口”。联合使用强心、利尿、血管扩张剂治疗可获得良好效果，在连续硬膜外麻醉下行剖宫产术终止妊娠是抢救母婴生命的有效措施。

Objective:We explore the management method and delivery manner for perinatal cardiac failure patient ,complicated with heart disease during pregnancy.Methods:We carried a retrospective analysis of clinic data for 176 cases of pregnancy with heart disease during 1989～1998.Results:It reveals that pregnancy with heart disease occurred at rate 1.5%,compared its proportion composition,the rheumatic heart disease is the first one ,congenital heart disease,carditic,pregnancy induced hypertension heart disease located at second,third ,and fourth ,In this article,92 cases (52.3%) with grade Ⅱ～Ⅳ cardiac function,including 56 cases with left heart failure,7 cases with right heart failure,29 cases with pan heart failure ,during pregnancy 32 weeks to 36 weeks,65 cases (70.7%)occurred heart failure,20 cases (21.7%) occurred heart failure after preganancy 36 weeks.7 cases with acute pulmonary edema during delivery course ,these were cases of rheumatic heart disease,MS with Af .108 cases (61.4%) performed with casarean section,within which,77 cases with grade Ⅰ～Ⅱ cardiac function,31 cases with grade Ⅲ～Ⅳ cardiac function,3 cases of neonate death ,all died from intrauterine anoxemia,3 cases of puerperas death,2 cases died from acute pulmonary edema after delivery,one case died from ventricular fibrillation.Conclusion:We should put emphasis on the treatment and prevention for early cardiac failure,and grasp the “Triple Key point”for the Pregnancy 32 weeks to 36 weeks,the second delivery course, and the time after delivery ,we could use digitalis drugs ,diuretics, and vessel dilators to treat the patients and get excellent effect ,and there is an effective method to terminate the delivery to save the mother and baby,and perform cesarean section with continuous extradural anesthesia.