房间隔缺损产妇新生儿临床资料分析

Clinical analysis of neonates of puerpera with atrial septal defect

目的 分析房间隔缺损（ASD）产妇所生产新生儿临床资料,探讨产妇ASD对新生儿的影响.方法 回顾性分析2003年1月至2013年10月首都医科大学附属北京安贞医院收治的83例ASD产妇所生产83名新生儿（观察组）的临床资料,另选取同期健康产妇所生产新生儿136名为对照组.比较2组新生儿出生体质量和身长及早产儿、小于胎龄儿和窒息发生率.结果 观察组新生儿出生体质量和身长均明显低于对照组[（2 946±547）g比（3 187 ±420）g、（48.9 ±2.3）cm比（50.4±1.7）cm],早产儿和小于胎龄儿发生率高于对照组[19.3％（16/83）比8.1％ （11/136）,8.4％ （7/83）比0.7％ （1/136）],差异有统计学意义（P＜0.05）,窒息发生率与对照组比较差异无统计学意义[6.0％（5/83）比1.5％ （2/136）] （P＞0.05）.观察组中合并肺动脉高压产妇37例,其新生儿出生体质量为（2 727±616）g,身长为（47.9±3.0）cm,早产儿和小于胎龄儿发生率分别为35.1％ （13/37）和10.8％ （4/37）,与对照组比较差异有统计学意义（P＜0.05或P＜0.01）,新生儿窒息发生率为10.8％ （4/37）,与对照组比较差异无统计学意义（P＞0.05）.观察组早产儿、小于胎龄儿和窒息发生率在美国纽约心脏病协会心功能分级Ⅰ级产妇中分别为6.7％（2/30）、13.3％（4/30）和3.3％ （1/30）,Ⅱ级产妇中分别为19.0％（8/42）、2.4％ （1/42）和2.4％（1/42）,Ⅲ～Ⅳ级产妇中分别为54.5％（6/11）、18.2％（2/11）和27.3％（3/11）.结论 ASD产妇,尤其是合并肺动脉高压产妇所生产新生儿出生体质量和身长低于正常孕妇新生儿,早产儿、小于胎龄儿发生率高于正常孕妇新生儿;心功能Ⅲ～Ⅳ级孕妇早产儿和新生儿窒息发生率高.

Objective To analyze the clinical data of neonatus of puerperal with atrial septal defects （ASD） and to explore the influence of maternal ASD on the neonatus.Method Clinical data of 83 neonates of 83 puerperas with ASD （obserwation group） and 136 neonates of healthy puerperas （control group） from January 2003 to October 2013 was retrospectively analyzed.The birth weight,birth height,incidences of premature birth,small for gestational age and neonatal asphyxia were compared between the two groups.Result In observation group,the birth weight and birth height were significantly less,the incidences of premature birth and small for gestational age were significantly higher compared with those in control group [（2 946 ± 547） g vs （3 187 ± 420） g,（48.9±2.3） cmvs （50.4±1.7） cm,19.3% （16/83） vs8.1% （11/136）,8.4% （7/83） vs0.7% （1/136）] （P 〈 0.05）,while no significantly difference was found regarding incidence of neonatal asphyxia [6.0% （5/83） vs 1.5% （2/136）] （P 〉0.05）.In observation group,37 puerperas were complicated with pulmonary arterial hypertension and their neonates had less birth weight [（2 727 ± 616）g] and birth height [（47.9 ± 3.0）cm],higher incidences of premature birth [35.1% （13/37）] and small for gestational age [10.8% （4/37）],similar incidence of neonatal asphyxia [10.8% （4/37）] compared with those in control group.The incidences of premature birth,small for gestational and neonatal asphyxia were 6.7% （2/30）,13.3% （4/30） and 3.3% （1/30） in puerperas of New York heart association （NYHA） class Ⅰ,19.0% （8/42）,2.4% （1/42） and 2.4% （1/42） in puerperas of NYHA class Ⅱ,54.5% （6/11）,18.2% （2/11） and 27.3% （3/11） in puerperas of NYHA class Ⅲ-Ⅳ.Conclusions The neonates of puerperas with ASD,especially those complicated with pulmonary arterial hypertension,have less birth weight and birth height,higher incidences of premature birth and small for gestational age compared with common neonates;the incidence of premature birth and neonatal asphyxia are higher for pregnant women of NYHA class Ⅲ-Ⅳ.