妊娠合并主动脉夹层或合并主动脉瘤的临床分析

Clinical features of pregnancy complicated with aortic dissection or aortic aneurysm

目的 研究妊娠合并主动脉夹层或合并主动脉瘤患者的临床分析。方法 回顾性分析2006年 1月至2016年2月于首都医科大学附属北京安贞医院分娩的合并主动脉夹层或合并主动脉瘤的32例孕产妇作为病例组。选择同期本院分娩的无合并主动脉夹层或合并主动脉瘤的65例孕产妇作为对照组。根据妊娠合并疾病类型，将病例组分为主动脉夹层组（24例）和主动脉瘤组（8例）；将对照组分为正常组（35例）和高血压组（30例）。收集和分析所有孕产妇临床资料。结果 主动脉夹层组孕产妇死亡率和胎儿丢失发生率明显高于正常组、高血压组和主动脉瘤组，差异均有统计学意义（均P＜0.05）。高血压组的早产儿发生率均明显高于其他3组，差异有统计学意义（P＜0.05）。主动脉瘤组和主动脉夹层组早产儿发生率明显高于正常组，差异有统计学意义（P＜0.05）。主动脉夹层组终止妊娠孕周小于正常组、高血压组和主动脉瘤组［30（22，35）周比37（37，38）、36（32，38）、32（14，38）周］，胸背痛发生率高于其他3组［100.0%（24/24）比0.0%（0/35）、0.0%（0/30）、1/8］，主动脉宽度水平高于其他3组［（5.5±1.7）cm比（2.8±0.4）、（3.0±0.4）、（5.1±1.1）cm］，差异均有统计学意义（均P＜0.05）。主动脉瘤组主动脉宽度大于正常组和高血压组，差异有统计学意义（P＜0.05）。主动脉夹层组白细胞计数、中性粒细胞比例和中性粒细胞计数均高于其他3组，差异均有统计学意义（均P＜0.05）。主动脉瘤组中性粒细胞比例均低于正常组和高血压组，差异有统计学意义（P＜0.05）。4组D-二聚体水平比较，差异无统计学意义（P＞0.05）。结论 妊娠合并主动脉夹层或合并主动脉瘤的孕产妇以胸背痛为主要临床表现，关注主动脉和血压，结合辅助检查，做到初诊及时准确，保障母婴生命安全。

Objective To analyze clinical features of pregnancy complicated with aortic dissection or aortic aneurysm. Methods A total of 97 pregnant women with aortic dissection or aortic aneurysm from January 2006 to February 2016 in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed; 32 women had aortic dissection/aortic aneurysm（observation group）; 65 cases without aortic lesion were control group. The observation group was divided into aortic dissection group（24 cases） and aortic aneurysm group（8 cases）. The control group was divided into normal group（35 cases） and hypertension group（30 cases）. Clinical data were analyzed. Results The death rate and fetal loss rate in aortic dissection group were significantly higher than those in normal group, hypertension group and aortic aneurysm group（P〈0.05）. The preterm rate in hypertension group was significantly higher than that in normal group, aortic aneurysm group and aortic dissection group（P〈0.05）; the preterm rate in aortic aneurysm group and aortic dissection group were significantly higher than that in normal group（P〈0.05）. The gestational week in aortic dissection group was significantly less, the incidence of chest pain was significantly higher and the width of aorta was significantly wider than those in normal group, hypertension group and aortic aneurysm group[30（22, 35）weeks vs 37（37, 38）, 36（32, 38）, 32（14, 38）weeks; 100.0%（24/24） vs 0.0%（0/35）, 0.0%（0/30）, 1/8; （5.5±1.7）cm vs （2.8±0.4）,（3.0±0.4）,（5.1±1.1）cm]（P〈0.05）; the width of aorta in aortic aneurysm group was significantly wider than that in normal group and hypertension group（P〈0.05）. White blood cell count, neutrophil ratio and neutrophil count in aortic dissection group were significantly higher than those in other 3 groups（P〈0.05）; neutrophil ratio in aortic aneurysm group was significantly lower than that in normal group and hypertension group（P〈0.05）. The level of D-dimer had no significant difference among 4 groups（P〉0.05）. Conclusions Chest pain is a main clinical manifestation in pregnant women with aortic dissection or aortic aneurysm. Blood pressure monitoring and accessory laboratory examinations help timely diagnosis and ensure the safety of mother and baby.