妊娠章鱼壶心肌病的病例特点:60例文献复习

Clinical features of pregnant associated Takotsubo cardiomyopathy:a literature review of 60 cases

目的总结妊娠章鱼壶心肌病(pregnant associated Takotsubo cardiomyopathy,PTCM)的临床特点。方法在万方数据和中华医学期刊网,以“应激性心肌病”“章鱼壶综合征”“心尖部气球样变”“心尖气球样”“心尖球形”“Tako-tsubo”“Takotsubo”“Takotsubo心肌病”“Tako-tsubo综合征”“Takotsubo综合征”“Takotsubo样心肌病”和“妊娠”“分娩”“剖宫产”“产后”“围产期”“子痫”“流产”为关键词;在Pubmed和Web of Science数据库,以“Tako-tsubo cardiomyopathy”“Takotsubo cardiomyopathy”“Stress cardiomyopathy”AND“parturition”“pregnancy”“cesarean delivery”“postpartum”“peripartum”“eclampsia”“abortion”为关键词,检索2007年1月至2022年6月发表的PTCM病例。总结患者的年龄、孕产史、分娩方式、麻醉方式、发病诱因、临床表现、支持治疗和预后。采用描述性统计分析。结果共纳入55篇文献,共60例PTCM患者。(1)发病年龄和时间:患者发病年龄为(32.4±6.0)岁。PTCM最常发生于产程中[42%(25/60)]和产后1 d内[32%(19/60)],其次是妊娠期间[13%(8/60),孕33.0周(24.5~37.7周)]。(2)分娩相关因素:初产和经产妇分别为占38%(16/42)和60%(25/42)。剖宫产和阴道分娩者分别占67%(38/57)和18%(10/57)。PCTM大多无明显诱因[40%(24/60)],最常见的诱因是妊娠相关疾病[27%(16/60)]。(3)临床特征:PTCM首发症状主要为呼吸困难[44%(26/59)],其次为胸痛合并呼吸困难[17%(10/59)]。PTCM分类中最常见心尖型[45%(26/58)],其次为基底型[24%(14/58)],双心室型最少[3%(2/58)]。PTCM发病时左心室射血分数为(31.6±12.1)%,出院时恢复至(58.2±7.6)%。PCTM常合并肺水肿[67%(40/60)]和心源性休克[55%(33/60)]。(4)治疗和预后:PTCM患者通常需要接受无创或有创呼吸机辅助通气[40%(23/58)]。1例孕妇和5例新生儿死亡,其余患者均恢复良好。结论产程中和妊娠期出现呼吸困难、胸痛的患者,在鉴别诊断时需要考虑到PTCM。PTCM患者发病年龄轻,合并肺水肿和心源性休克比例高,常需要机械辅助通气,但预后多较良好。

Objective To investigate the clinical features of pregnant associated Takotsubo cardiomyopathy(PTCM).Methods We reviewed reported PTCM cases published from January 2007 to June 2022 using the keywords"Tako-tsubo cardiomyopathy""Takotsubo cardiomyopathy""stress cardiomyopathy"AND"parturition""pregnancy""cesarean delivery""postpartum""peripartum""eclampsia""abortion"in Pubmed and Web of Science databases and the corresponding Chinese words in Wanfang and Chinese Medical Journal Network.Age,obstetric history,mode of delivery,mode of anesthesia,etiological factors,clinical manifestations,treatment,and prognosis of PTCM were recorded.Descriptive statistical analysis was adopted.Results A total of 55 articles were included,covering 60 patients with PTCM.(1)Age and time of onset:The age of onset was(32.4±6.0)years old.PTCM occurred most frequently during labor[42%(25/60)]and within one day postpartum[32%(19/60)]and during the gestational period[13%(8/60),33.0 weeks(24.5-37.7 weeks)].(2)Delivery-related factors:There were 38%(16/42)primiparas and 60%(25/42)multiparas.Among them,67%(38/57)and 18%(10/57)were delivered by cesarean section and vaginal delivery,respectively.PCTM often lacks obvious triggers[40%(24/60)],with the most common inducing factor being pregnancy-related diseases[27%(16/60)].(3)Clinical features:The initial symptoms of PTCM were dyspnea[44%(26/59)],followed by chest pain accompanied by dyspnea[17%(10/59)].The most common subtype of PTCM was the apical type[45%(26/58)],followed by the basal type[24%(14/58)],while the biventricular type was the least common[3%(2/58)]in the PTCM classification.The left ventricular ejection fraction was(31.6±12.1)%at the onset of PTCM,which recovered to(58.2±7.6)%at discharge.PCTM was often complicated by pulmonary edema[67%(40/60)]and cardiogenic shock[55%(33/60)].(4)Treatment and prognosis:Patients with PCTM usually require noninvasive or invasive ventilator-assisted ventilation[40%(23/58)].One pregnant woman and five neonates died,while the remaining patients recovered well.Conclusions PTCM should be considered in differential diagnosis of patients experiencing dyspnea and chest pain during labor and pregnancy.PTCM patients are younger and have more pulmonary edema and cardiogenic shock.Mechanical ventilation is often required,but the prognosis is favorable.