心脏病孕产妇发生围产儿并发症的危险因素分析及风险指数测定的研究

The study of risk factors and risk index of perinatal events in women with heart disease

目的:探讨妊娠合并心脏病患者发生围产儿并发症的主要危险因素,在此基础上拟定风险指数测定。方法:回顾分析1993年1月至2010年8月在我院产科心脏病监护中心分娩的1725例妊娠合并心脏病患者的临床资料。采用Logistic回归分析预测心脏病孕产妇发生围产儿并发症的独立危险因素,并计算围产儿风险指数。结果:(1)妊娠合并心脏病患者主要的心脏病类型为先天性心脏病529例(30.67%)、风湿性心脏病151例(8.75%)、心律失常662例(38.38%)、心肌疾病327例(18.96%)和妊娠期高血压性心脏病53例(3.07%)。(2)围产儿并发症主要为早产儿215例(12.46%)、小于胎龄儿90例(5.22%)、新生儿窒息43例(2.49%)及围产儿死亡56例(3.25%)。(3)心脏病孕产妇发生围产儿并发症的独立危险因素为双胎妊娠(P=0.000)、孕前发生过心脏事件(心衰、严重心律失常、心源性休克)(P=0.003)、心功能>Ⅱ级(P=0.000)、未手术纠正的紫绀型心脏病(P=0.000)、氧饱和度<90%(P=0.003)、肺动脉高压≥50mmHg(P=0.000)、左心梗阻(P=0.009)。(4)每个独立危险因素占1分。0、1、2、3、≥4分的患者发生围产儿并发症的概率分别为9.52%、40.00%、69.70%、85.29%和93.33%。结论:妊娠合并心脏病可导致围产儿严重不良结局,妊娠合并心脏病患者发生围产儿并发症的风险可由风险指数来判定。

Objective：To investigate the predictors of perinatal events in women with heart disease and make risk assessment to ensure the good pregnancy outcome.Methods：A retrospective analysis was carried out on clinical data of 1725 patients with heart disease who delivered in Shanghai Obstetrical Cardiology Intensive Care Center between Jan.1993 and Aug.2010.Independent predictors of perinatal events were calculated using logistic regression.Results：（1）The common kinds of heart diseases were congenital heart disease,rheumatic heart disease,arrhythmia[662（38.38%）],cardiomyopathy[327（18.96%）],and cardiopathy induced by hypertensive disorders[53（3.07%）].（2）The predominant perinatal events were preterm delivery[215（12.46%）],small for gestational age[90（5.22%）],neonatal asphyxia[43（2.49%）]and perinatal death[56（3.25%）].（3）Independent predictors associated with perinatal events were bigeminal pregnancy（P=0.000）,cardiac events before pregnancy include heart failure、severe arrhythmia、cardiac shock（P=0.003）,NYHA functional class of ＆gt;Ⅱ（P=0.000）,presence of cyanotic heart diseases without surgery（P=0.000）,Oxygen saturation＆lt;90%（P=0.003）,pulmonary hypertensin≥50mmHg（P=0.000） and left heart obstruction（P=0.009）.（4）Every risk factor was calculated 1 score.The incidence of perinatal events in patients with 0,1,2,3,≥4 score was 9.52%,40.00%,69.70%,85.29%,93.33% respectively.Conclusion：Heart disease in pegnancy can induce poor perinatal outcome and the risk of perinatal events could be evaluated by risk index.