妊娠并发心脏病患者自然分娩的心血管风险评估体系的构建

Construction of a cardiovascular risk assessment system for spontaneous delivery in pregnant women with heart disease

目的构建适用于临床的妊娠并发心脏病患者自然分娩心血管风险评估体系,用于医护人员在妊娠并发心脏病患者自然分娩前进行评估,判断相关心血管疾病发生的可能性。方法选择2014年6月至2017年6月中国人民解放军第175医院自然分娩的200例妊娠并发心脏病患者心血管数据为研究对象。参照世界卫生组织(WHO)风险评估系统,通过前期对妊娠并发心脏病患者自然分娩进行问卷调查、专家访谈、文献查证和Meta分析,形成妊娠并发心脏病患者自然分娩心血管风险评估指标体系,采用改良德尔菲法对10位专家进行咨询和重要性评分,用Excel和SPSS软件计算各指标的权重并最终确定风险评估体系。结果依据妊娠并发心脏病患者心血管相关的风险因素,初步构建了由4个一级指标以及下设的31个二级指标的妊娠并发心脏病患者自然分娩心血管风险评估指标体系,其中Ⅰ度风险评估指标下设7个二级风险评估;Ⅱ度风险评估指标下设9个二级风险评估;Ⅲ度风险评估指标下设7个二级风险评估;Ⅳ度风险评估指标下设8个二级风险评估。结论初步建立了妊娠并发心脏病患者自然分娩心血管风险评估指标体系,能据此指标体系进行风险评估,从而根据不同患者的具体情况,有针对性地制定护理方案,最终达到预防和减少妊娠并发心脏病患者自然分娩心血管疾病的发生。

Objectives To construct a clinical suitable natural childbirth cardiovascular risk assessment system forpregnancy patients with heart disease,in order to offer a system for medical staff assessment to judge cardiovasculardisease occurrence before natural childbirth. Methods Cardiovascular data of 200 pregnant women with heart diseasewho underwent spontaneous delivery from June 2014 to June 2017 in No.175 Hospital of PLA were selected as thesubjects. According to the World Health Organization（WHO）risk assessment system,through the analysis of question-naire survey,expert interviews,literature review and Meta on natural childbirth of pregnant women with heart disease,natural childbirth cardiovascular risk assessment system for pregnancy patients with heart disease was formed. Tenexperts were consulted and scored by modified Delphy method. Excel and SPSS software were used to calculate theweight of each index and ultimately determine the risk of the assessment system. Results On the basis of cardiovascularrisk factors in patients with pregnancy complicated with heart disease,natural childbirth cardiovascular risk assessmentsystem for pregnancy patients with heart disease was initially constructed. This system was formed by 4 first levelindicators and 31 second indicators. TheⅠdegree risk assessment index including 7 second risk assessment indexes.The Ⅱdegree risk assessment index including 9 second risk assessment indexes. The Ⅲ degree risk assessment indexincluding 7 second risk assessment indexes. The Ⅳdegree risk assessment index including 8 second risk assessment indexes. Conclusions Natural childbirth cardiovascular risk assessment system for pregnancy patients with heartdisease is preliminary established,which can evaluate the risk. According to the specific circumstances of differentpatients,to develop targeted nursing program,to prevent and reduce the occurrence of heart disease in pregnancypatients with cardiovascular disease.