妊娠合并心脏病812例临床分析

Pregnancy Complicated with Heart Disease: Clinical Analysis of 812 Cases

目的:探讨妊娠合并不同种类心脏病患者的母儿预后。方法:对我院2002年3月至2012年5月间收治的812例妊娠合并心脏病患者的有关临床资料进行回顾分析。结果:1).研究的470例妊娠合并先心病患者平均年龄为30.0±4.7岁,101例妊娠合并风心病患者平均年龄为30.1±4.8岁,241例妊娠合并其它心脏病患者平均年龄为29.1±4.5岁。470例妊娠合并先心病患者初产妇为425例,101例妊娠合并风心病患者初产妇为74例,241例妊娠合并其它心脏病患者初产妇为200例。三组患者的心脏病史相比较,差异有统计学意义;三组并发症相比较,差异无统计学意义。2).妊娠合并先心病和风心病从2002年到2012年每年的发病均呈递增的趋势;妊娠合并其它心脏病的发病高峰在2007年至2010年。3).妊娠合并先心病组同妊娠合并风心病组及妊娠合并其它心脏病组的新生儿不良结局的比较结果中,新生儿死亡及早产比较,差异有统计学意义。窒息、低体重儿、脐绕颈、胎儿窘迫的比较,差异无统计学意义。4).在母亲妊娠结局方面,三组的剖宫产、胎盘残留、产褥病率及脐带异常相比较,差异均无统计学意义。心律失常及其它并发症比较,P<0.001,差异有统计学意义。结论:对于妊娠合并不同心脏病患者的母儿预后的影响有待更多研究,加强孕前心脏病史的管理可以显著改善母儿预后,临床上应重视合并心脏病孕妇的孕前咨询、产前检查和孕期保健,强调对其妊娠期、分娩期、产褥期进行多学科、规范化管理,剖宫产是较为安全的分娩方式。

Objective： To investigate the maternal-fetal outcomes in pregnant women complicated with different types of heart diseases.Methods： Clinical data of 812 pregnant cases with either rheumatic or congenital heart diseases,collected from Beijing Anzhen Hospital during 2002.3～2012.5,were analysed retrospectively.Results： 1.Study of 470 cases of pregnancy complicated with heart disease patients had a mean age of 30± 4.7 years,101 cases of pregnancy complicated with rheumatic heart disease patients with a mean age of 30.1± 4.8 years,241 cases of pregnancy complicated with other heart disease patients had a mean age of 29.1± 4.5 years.470 cases of pregnancy complicated with congenital heart disease patients with primipara for 425 cases,101 cases of pregnancy complicated with rheumatic heart disease patients of primipara for 74 cases,241 cases of pregnancy complicated with other patients with heart disease for 200 cases of primipara.In three groups of patients with a history of heart disease are compared,the difference was statistically significant;complications in the three groups compared,the difference was not statistically significant.2.Pregnancy complicated with congenital heart disease and rheumatic heart disease from 2002 to 2012 the annual incidence was increasing trend;pregnancy associated with other heart disease incidence peaks in 2007 and 2010.3.Pregnancy complicated with heart disease in pregnancy complicated with rheumatic heart disease group with pregnancy complicated with heart disease group and the other group of adverse neonatal outcome comparison results in neonatal death and premature birth,comparison,the difference was statistically significant.Asphyxia,low birth weight,umbilical cord around the neck,fetal distress in comparison,the difference was not statistically significant.4.In the mother＇s pregnancy outcome,three groups of cesarean section,residual placenta,puerperal morbidity and umbilical cord abnormalities in comparison,there were no significant differences.Cardiac arrhythmias and other complications in comparison,P0.001,the difference was statistically significant.Conclusions： For patients with heart disease in pregnancy complicated with different maternal and perinatal prognosis influence needs more investigation,enhance pre-pregnancy heart disease management can significantly improve the prognosis of mothers and infants,clinical emphasis should be paid on patients with heart disease in maternal pre-pregnancy counselling,prenatal examination and pregnancy care,emphasis on pregnancy,childbirth,postpartum multidisciplinary,specification management,cesarean section is relatively safe delivery.