妊娠合并心脏病患者的妊娠风险度评估研究

Risk index for pregnancy outcomes in patients with heart disease

目的研究分析量化心脏相关高危风险指标在判断妊娠合并心脏病患者妊娠结局的独立或综合价值。方法选择1999年1月至2008年12月广东省人民医院收治的416名孕妇共535次妊娠,这些孕妇包括先天性心脏病和获得性心脏病患者。将孕妇分为预测发生心脏事件组和实际发生心脏病事件组,就影响发生心脏事件各种相关因素进行综合分析。结果妊娠前发生心功能衰竭、休克、一过性缺血性发作、妊娠前心律失常、初次产前检查心功能III级或以上、发绀、左心梗阻、左心射血功能不全均为影响妊娠结局的高危风险因素,每一项因素量化为1分作为风险预测值,风险预测值为0,1,﹥1分时,发生心脏事件的风险分别为5%,27%和75%。结论临床上应用风险指标评分可初步预测妊娠合并心脏病患者心脏事件的发生。

Objectives To assess the valve of predictors of pregnancy-related complications for pregnancy outcomes in patients with heart disease. Methods We enrolled 416 consecutive pregnancy women with heart disease who determined the outcomes of 535 pregnancies not ending in miscarriage from Feb 1999 to Dec 2008. These pregnant women included patients with congenital, acquired cardiac lesions and cardiac arrhythmias. Pregnancy women with heart disease were divided into derivation and validation groups for the analysis of predictors of pregnancy-related complications. Results Prior cardiac events or arrhythmia, poor functional class or cyanosis, left heart obstruction and left ventricular systolic dysfunction independently predicted maternal cardiac complications. The cardiac event rate can be predicted using a risk index incorporating these predictors. The estimated risk of a cardiac event in pregnancies with 0, 1 and〉1 point was with 5%, 27% and 75% respectively. Conclusions Pregnancy in women with heart disease is associated with significant cardiac complications. Maternal cardiac risk can be predicted with the use of a risk index.