多学科协作诊疗模式管理提高妊娠合并心脏病的效果

Multi-disciplinary team improving the outcomes of pregnancy with heart disease

目的分析北部战区总医院参加孕产期母儿心脏病多学科协作诊疗模式(MDT)会诊妊娠合并心脏病孕产妇的临床资料,总结诊治经验。方法本研究为回顾性研究,选取2018年1月至2020年12月参加北部战区总医院孕产期母儿心脏病MDT会诊的162例女性妊娠合并心脏病患者,其中120例在北部战区总医院妇产科及心外科持续随访和接受手术,其余42例转至当地医院继续诊治。纳入研究的120例妊娠合并心脏病患者,年龄(29.47±4.54)岁,年龄范围为19~47岁,回顾性分析其合并心脏病的疾病种类、心功能分级、心脏病妊娠风险分级、分娩结局等。结果先天性心脏病为58.3%(70/120),无心脏结构异常的心律失常为30.0%(36/120),瓣膜性心脏病为8.4%(10/120),原发性肺动脉高压为1.7%(2/120),妊娠期高血压疾病性心脏病为0.8%(1/120),围产期心肌病为0.8%(1/120)。心功能Ⅰ级为67.5%(81/120),Ⅱ级为19.1%(23/120),Ⅲ级为6.7%(8/120),Ⅳ级为6.7%(8/120)。心脏病妊娠风险分级Ⅰ级为23.3%(28/120),Ⅱ级为45.8%(55/120),Ⅲ级为14.2%(17/120),Ⅳ级为10.8%(13/120),Ⅴ级为5.9%(7/120)。活产为89.2%(107/120),发生医源性胎儿丢失为10.8%(13/120)。结论妊娠合并心脏病患者要早治疗、早诊断、早干预,多学科诊疗模式覆盖孕前评估、孕期监测、产时及产后管理,最大程度保障妊娠合并心脏病患者的母儿安全。

Objective To analyze the clinical data of pregnant women with heart disease who participated in multi-disciplinary team(MDT)consultation during pregnancy and perinatal period in the The General Hospital of Northern Theater,to summarize the experience of diagnosis and treatment.Methods This study was a retrospective study,a total of 162 female pregnant patients with pregnancy complicated with heart disease who participated in MDT consultation of maternal and fetal heart disease during pregnant and puer-peral period in General Hospital of Northern Theater Command from January 2018 to December 2020 were selected,among which 120 patients were continuously followed up and operated in department of Obstetrics and Gynecology and Cardiovascular Surgery of General Hospital of Northern Theater Command,and the remaining 42 patients were transferred to local hospitals for further diagnosis and treatment.The 120 patients with pregnancy complicated with heart disease were included in the study,with the age(29.47±4.54)years old,ranged from 19 to 47 years old.Types of disease complicated with heart disease,cardiac function grades,pregnancy risk grades of heart disease,delivery outcomes and others were analyzed retrospectively.Results Congenital heart disease was 58.3%(70/120),arrhythmia without cardiac structural abnormality was 30.0%(36/120),valvular heart disease was 8.4%(10/120),primary pulmonary hypertension was 1.7%(2/120),hypertensive disorders in pregnancy was 0.8%(1/120),perinatal cardiomyopathy was 0.8%(1/120).Cardiac function gradeⅠwas 67.5%(81/120),cardiac function gradeⅡwas 19.1%(23/120),cardiac function gradeⅢwas 6.7%(8/120),and cardiac function gradeⅣwas 6.7%(8/120).The pregnancy risk classification of heart disease:gradeⅠwas 23.3%(28/120),gradeⅡwas45.8%(55/120),gradeⅢwas14.2%(17/120),gradeⅣwas 10.8%(13/120),and gradeⅤwas 5.9%(7/120).live birth was 89.2%(107/120),iatrogenic fetal loss was 10.8%(13/120).Conclusions Patients with heart disease in pregnancy should be treated,diagnosed and intervened as early as possible.The multi-disciplinary model brings together doctors from different disciplines to carry out pre-pregnancy evaluation,pregnancy monitoring,delivery and postpartum management for patients,so as to ensure the safety of mothers and children of patients with heart disease in pregnancy to the greatest extent.