法洛四联症患者妊娠安全性探讨

Pregnancy Safety in Women with Tetralogy of Fallot

目的:探讨法洛四联症(TF)患者妊娠安全性的相关因素。方法:对上海仁济医院1993年1月至2015年6月收治的70例妊娠合并TF患者的临床资料进行回顾性分析。结果:(1)70例妊娠合并TF患者成功妊娠61例(87.1%),无孕产妇死亡,孕妇发生心脏并发症主要为心力衰竭(5例,7.14%),其中孕前未行心脏矫治手术3例,心脏矫治术后仍然有结构异常2例。(2)孕前行心脏矫治手术的TF患者(47例),其血红蛋白(Hb)、血细胞比容(HCT)、氧饱和度(≥0.90)、氧分压值、心脏彩色超声检查结果(右心室肥厚、肺动脉狭窄、室间隔缺损的比例)均明显优于孕前未行手术者(23例)(P<0.05)。(3)围生儿存活61例(87.14%),足月产47例(67.14%)。围生儿不良结局包括早产14例(20.00%),小于胎龄儿14例(20.00%),新生儿窒息2例(2.86%),新生儿心脏畸形3例(4.29%),新生儿死亡1例(1.43%),治疗性流产8例(11.43%)。(4)孕前手术矫正者的足月产率、分娩天数、新生儿出生体质量及治疗性流产、小于胎龄儿、新生儿心脏畸形的发生率均明显优于孕前未手术者(P<0.05)。(5)氧饱和度<0.90是预测TF患者及其围生儿不良结局的独立危险因素(P<0.05)。结论:妊娠合并TF可导致孕产妇及围生儿不良结局,孕前行心脏矫治手术可改善母体妊娠情况及母儿结局。孕期应重视对孕妇氧饱和度及Hb、HCT和心脏彩超检查指标的监测。未手术矫正或者心脏矫治术后仍然有结构异常者要严格掌握妊娠指征。

Objective： Studies of risky factors are of great significance to maternal and fetal outcomes in patients with Tetralogy of Fallot（ TOF）. Methods： A retrospective analysis was carried out for pregnancies in 70 women with TOF who delivered in Shanghai Obstetrical Cardiology Intensive Care Center between Jan 1,1993 and Jun30,2015.Results： 1 Of all 70 patients,61 pregnancies were successful,there was no maternal death. The most maternal cardiac complication was cardiac failure.Three patients without cardiac surgery and two patients with residual cardiac defects after surgery had cardiac failure during pregnancy（ 7. 14%）.2In patients with surgery,hemoglobin and hematocrit,the oxygen saturation and oxygen pressure,and the echocardiography data（ the proportion of right ventricular hypertrophy,pulmonary stenosis and ventricular septal defect） were improved significantly（ P〈0. 05）.3The perinatal survival rate was 87. 14%.There were 47 term deliveries（ 67. 14%）,perinatal poor outcomes include 14 premature delivery,14 small birth weight for gestational age,2 neonatal asphyxia,3 neonatal heart malformation,1 neonatal death and 8 therapeutic abortion.4In patients with cardiac surgery before conception,the full-term birth rate,average gestational age,average birth weight were increased,the rate of the rapeutic abortion,small for gestational age and neonatal cardiac malformations were decreased（ P〈0. 05）.5Oxygen saturation below 0. 90 was the independent risk factor to predict cardiac complications and perinatal poor outcomes（ P〈0. 05）. Conclusions： Cardiovascular,perinatal complications occur frequently during pregnancies in women with TOF.The outcome of pregnancy in women with repaired TOF could be improved.We should pay attention to the monitor of HB,HCT,oxygen saturation and echocardiography during pregnancy. Women with unrepaired TOF or still have residual cardiac defects after surgery pregnancy should be strictly controlled.