摘要
目的:总结分析12例先天性心脏病(先心病)伴重度肺动脉高压孕产妇死亡的临床特点及相关因素、吸取经验,以便更好指导今后临床工作。方法:回顾性分析安贞医院2002年9月至2014年3月,收治12例先心病伴重度肺动脉高压孕产妇死亡病例的临床资料,并与同时期未死亡先心病伴重度肺动脉高压孕产妇86例做对比分析。先心病类型有:房间隔缺损、动脉导管未闭、室间隔缺损、复杂先心(心内膜垫缺损、巨大房间隔缺损)及右心室双出口。结果:12例死亡病例中:孕期死亡3例,9例终止妊娠后死亡,其中6例进入围产期行剖宫产术,1例晚期流产经阴道分娩,2例剖宫取胎终止妊娠,医疗干预终止妊娠率66.7%。12例死亡病例全部心功能≥III级,心功能III级1例(8.3%),心功能IV级11例(91.7%)。86例未死亡病例中:人工流产术28例,剖宫取胎术33例,剖宫产术24例,经阴道分娩1例,医疗干预终止妊娠率98.8%。心功能<III级46例(53.5%),心功能≥III级40例(46.5%)。两组在心功能及医疗干预终止妊娠率方面比较,差异有统计学意义(P<0.05)。在平均肺动脉压,平均氧饱和度,平均血氧分压方面,死亡病例与未死亡病例比较有加重趋势,但差异无统计学意义(P>0.05)。98例先心病伴重度肺动脉高压病例汇总分析:早期妊娠28例,无死亡病例;中期妊娠37例,死亡4例(10.8%);晚期妊娠33例,死亡8例(24.2%),死亡率随孕周增加明显升高。患者死亡原因主要为肺动脉高压危象、多器官衰竭、呼吸衰竭、心力衰竭及室性心动过速。结论:先心病伴重度肺动脉高压属妊娠禁忌证,妊娠、产后加重心肺负担,易引起致命性并发症、病死率极高,故此类患者发现妊娠应尽早进行医疗干预。
Objective:To summarize the clinical characteristics and related factors of death cases in pregnancy or postpartum women with congential heart disease (CHD) with severe pulmonary arterial hyperten- sion (PAH) , for better future clinical work. Methods:A retrospective analysis of 12 death and 86 survival cases of AnZhen hospital from september 2002 to march 2014. Tapes of congenital heart disease including :atrial sep- tal defect(ASD) ,ventricular septal defect ( VSD ), patent ductus arteriosus ( PDA), complex congenital heart disease (CCHD),double outlet right ventricular(DORV). Results:The 12 death cases:three of them died in pregnancy,9 died after delivery. Modes of delivery:l vaginal delivery, 6 cesarean sections ( ~〉28 weeks) ,2 ce- sarean sections( 〈 28 weeks). The percent of medical termination of pregnancy was 66. 7%. There were 1 case (8. 3% ) with NYHA class III and 11 cases (91.7%) with NYHA class IV. The 86 survival cases included 28 artificial abortions,33 cesarean sections ( 〈 28 weeks) ,24 cesarean sections ( ~〉28 weeks) and 1 vaginal deliv- ery. The percent of medical termination of pregnancy is 98. 8%. There were 46 cases with NYHA class 〈III and 40 cases with NYHA class ≥ III. Compared with cardiac fucation and percent of medical termination of preg-nancy in two groups, the differences between the two groups were significantly ( P 〈 0. 05 ). But pulmonary ar- terial hypertension,oxygen saturation and oxygen partial pressure were no difference between the two groups(P 〉 0. 05). In all the 98 cases:no death cases in firse trimester pregnancy,4 death cases (10. 8% )in second tri- mester pregnancy and 8 death cases (24. 2% )in third trimester pregnancy, mortality was increased with the ges- tational weeks. The reasons of death were pulmonary hypertension crisis ( PHC ) , multiple organ dysfunction syndrome ( MODS), respiration failure ( RF), heart failure ( HF), malignant arrhythmia. Conclusion: In preg- nancy or postpartum the functions of cardiopulmonary could be worse in women with CHD with severe PAH, e- ven lead to death, so medical interventions should be taken as early as possible.
出处
《心肺血管病杂志》
CAS
2015年第1期23-26,共4页
Journal of Cardiovascular and Pulmonary Diseases
关键词
先天性心脏病
肺动脉高压
孕产妇
死因分析
Congenial heart disease
Pulmonary arterial hypertension
Pregnancy
Death analysis