围生期心肌病诊断与治疗的最新研究进展

Progress in Research on Diagnosis and Treatment of Peripartum Cardiomyopathy

围生期心肌病是一种特发性、妊娠相关的心肌病,病因还不清楚。其主要特征是既往健康的孕产期妇女,在妊娠晚期至产后5个月期间发生左心室收缩功能减退和心力衰竭。当妊娠晚期或产后早期出现心力衰竭体征时,要高度怀疑围生期心肌病,并早期开始防治。孕妇应避免使用血管紧张素转换酶抑制剂、血管紧张素受体拮抗剂及华法林,因为这些药有可能致畸。一旦分娩,就应该进行标准的心力衰竭治疗。患过围生期心肌病的妇女再次妊娠复发本病的风险很高。该病因与妊娠相关,在诊断和治疗上具有一定的特殊性,近来有不少小规模的前瞻性研究认为溴隐亭治疗围生期心肌病有良好的疗效。现着重针对围生期心肌病的诊断、药物治疗的最新进展进行综述。

Peripartum cardiomyopathy （PPCM） is an idiopathic, pregnancy related disease. PPCM ＇s pathogenesis has not been clear- ly identified. The principle characteristic of PPCM is that left ventricular systolic dysfunction and heart failure occur in the last month of preg- nancy or within 5-6 months postpartum in a previously healthy woman. PPCM should always be considered when there are signs of heart fail- ure in later pregnancy or early postpartum. Due to the presence of teratogens, pregnant women should avoid using angiotensin-converting en- zynle-inhibitors, angiotensin-Ⅱ receptor blockers, and warfarin, however, the standard treatment for heart failure should be given after deliv- ery. The risk of recurring PPCM is high in subsequent pregnancies. PPCM is related to pregnancy, so it has some particularity in its diagno- sis and treatment. Recently, many small studies have proposed that the use of bromocriptine for PPCM is effective. This article describes the newest diagnostic tools and therapy for PPCM.