晚期妊娠合并心脏病发生心力衰竭相关危险因素研究

Study on the related risk factors of heart failure among late pregnant women with heart diseases

目的探讨导致合并心脏病的晚期妊娠女性发生心力衰竭的危险因素。方法选择2012年5月-2015年5月在首都医科大学附属安贞医院住院的合并心脏病的晚期妊娠孕妇中心力衰竭患者80例为研究组,随机选择同期住院的晚期妊娠期合并心脏病但未发生心力衰竭患者80例为对照组,采用单因素分析和多因素Logistic回归分析晚期妊娠合并心脏病发生心力衰竭的危险因素。结果单因素分析结果显示,孕期血压升高、贫血、低蛋白血症、肺动脉高压、定期产检、血浆BNP的异常升高、射血分数的下降两组患者差异有统计学意义(P<0.05),产次、动脉血氧饱和度差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,孕期血压升高[OR=2.076,P=0.030]、贫血[OR=1.588,P=0.006]、低蛋白血症[OR=1.312,P=0.000]、中度肺动脉高压[OR=1.452,P=0.036]、重度肺动脉高压[OR=2.137,P=0.001],射血分数<50%[OR=1.103,P=0.035]、孕期规律产检[OR=0.446,P=0.016]进入回归方程。结论孕期血压升高、贫血、低蛋白血症、中-重度肺动脉高压、射血分数<50%为导致合并心脏病的晚期妊娠孕妇心力衰竭的危险因素,孕期规律产检为其保护性因素,孕期规律产检能有效控制这些危险因素可以改善妊娠合并心脏病患者的心功能,进而降低心力衰竭的发生率,改善整体患者的预后水平。

Objective To explore the risk factors of heart failure among late pregnant women with heart diseases. Methods Eighty hospitalized heart failure patients were selected from the late pregnant women with heart diseases in the hospital from May 2012 to May 2015 as study group, eighty hospitalized late pregnant women with heart diseases during the same period were randomly selected as control group. Univariate analysis and multivariate logistic regression analysis were used to analyze the risk factors of heart failure among late pregnant women with heart diseases. Results Univariate analysis showed that there were statistically significant differences in elevation of blood pres- sure during pregnancy, anemia, hypoalbuminemia, puhnonary hypertension, regular prenatal examination, abnormal increase of plasma BNP, decrease of ejection fraction between the two groups （ P〈0. 05 ） , but there was no statistically significant difference in parity and arterial oxygen saturation between the two groups （P〉0. 05 ） . Multivariate logistic regression analysis showed that elevation of blood pressure dur- ing pregnancy （ OR=2. 076, P=0. 030）, anemia （ OR= 1. 588, P=0. 006） , hypoalbuminemia （ OR = 1. 312, P=0. 000） , moderate pul- monary hypertension （ OR = 1. 452, P = 0. 036） , severe pulmonary hypertension （ OR = 2. 137, P = 0. 001 ） , ejection fraction〈50% （ OR = 1. 103, P=0. 035） , and regular prenatal examination （OR=0. 446, P=0. 016） entered the regression equation. Conclusion Elevation of blood pressure during pregnancy, anemia, hypoalbuminemia, moderate to severe pulmonary hypertension, and ejection fraction〈50% are risk factors of heart failure among late pregnant women with heart diseases ; regular prenatal examination is a protective factor of heart failure, which can effectively control these risk factors, improve heart function of the patients, reduce the incidence rate of heart failure, and improve prognosis of the patients.