妊娠合并风湿性心脏病25例临床分析

Clinical study on 25 cases of pregnancy complicated with rheumatic heart disease

目的探讨风湿性心脏病患者心脏手术和未心脏手术及不同心功能状态对分娩结局的影响。方法对2003年1月至2010年12月收治的25例风湿性心脏病孕妇妊娠结局进行回顾分析。1）根据孕期是否进行心脏手术分为心脏手术组10例（A组），未手术组15例（B组），对两组围产儿进行分析。2）根据患者的心功能状态分为I级组7例，Ⅱ级组9例，Ⅲ级组7例，Ⅳ级组2例。观察各组的围产儿结局。结果未心脏手术组与心脏手术组比较早产、FGR差异有统计学意义。心功能I级与Ⅱ级组足月分娩及新生儿出生体重比较，差异无统计学意义。结论风湿性心脏病手术后可明显改善妊娠结局，心功能Ⅲ～Ⅳ级患者围产儿结局不良，合并重度肺动脉高压及心房纤颤容易诱发心力衰竭，危及母婴生命，不宜妊娠。

Objective To investigate the outcome of pregnancy in pregnant women with rheumatic heart disease who had received a operation or without operation. Methods The clinical data of 25 pregnant women with heart diseases from Jan. 2002 to Dec. 2009 were analyzed retrospectively. （1） The 25 patients were divided into Group A （received heart surgery, n=10） and Group B （not received heart surgery, n=l 5）. The outcome of pregnancy was compared between the two groups. （2） The 25 patients were divided into four groups according heart function： Grade I （n=7）, Grade II （n=9）, Grade m （n=7）, Grade IV （n=2）. The outcome of pregnancy was compared between the four groups. Results The premature birth rate and fetal growth restriction （FGR） was significant higher in group A than group B. The rate of pregnancy at term and weight of neonate showed no statistically significant difference between Grade I and Grade II, but showed statistically significant difference between Grade I - II and Grade III- IV. conclusion Surgical interventions can improve the cardiac function, reduce the pregnancy complications and improve the pregnancy outcomes in pregnant women with rheumatic heart disease. The patient whose heart function of grade III-1V with atrial fibrillation and severe pulmonary hypertension tend to had a bad pregnancy outcomes.