合并主动脉夹层孕妇分娩新生儿院内结局及随访

Neonatal in-hospital outcomes and follow-up in pregnancies with aortic dissection

目的探讨孕母妊娠合并主动脉夹层(AD)对新生儿的近期及远期影响。方法回顾性队列研究。收集2010年6月至2022年6月首都医科大学附属北京安贞医院收治妊娠合并AD孕妇分娩的活产新生儿31例为夹层组,其中早产儿19例,为夹层早产组。选取同期孕检正常无妊娠合并症的孕妇所分娩的100例新生儿为正常对照组。选取同期无妊娠合并症的孕妇所分娩50例早产儿为对照早产组。采用两独立样本t检验,χ^(2)检验、Fisher′s精确检验,两两比较夹层组与正常对照组、夹层早产组与对照早产组的组间差异。对夹层组进行5年随访。结果1.夹层组的小于胎龄儿(SGA)(12.90%比1.00%)、新生儿呼吸窘迫综合征(NRDS)(16.13%比2.00%)、消化道出血(16.13%比1.00%)、神经系统疾病(16.13%比1.00%)、多脏器功能障碍综合征(MODS)(12.90%比0)、早产儿(61.29%比5.00%)、窒息(35.48%比1.00%)、心肺复苏(64.52%比1.00%)、呼吸机辅助呼吸(38.71%比2.00%)、出生24 h内转儿科(90.32%比13.00%)、剖宫产(100%比25.00%)、低出生体重儿(38.71%比2.00%)发生率均高于正常对照组,胎龄[(34.90±2.80)周比(38.87±1.50)周]、身长[(45.65±3.56)cm比(50.17±0.81)cm]、体重[(2456.77±634.02)g比(3383.90±413.05)g]均小于正常对照组,差异均有统计学意义(均P<0.05)。2.夹层早产组的胎龄[(33.26±2.31)周比(34.80±1.29)周]、身长[(43.89±3.36)cm比(46.64±2.89)cm]、体重[(2158.95±558.92)g比(2418.20±431.20)g]均小于对照早产组,NRDS(26.32%比4.00%)、消化道出血(21.05%比4.00%)、神经系统疾病(26.32%比6.00%)、MODS(21.05%比2.00%)、剖宫产(100%比52.00%)、心肺复苏应用(73.68%比8.00%)、呼吸机辅助呼吸(63.16%比10.00%)、窒息(47.37%比2.00%)发生率均高于对照早产组,差异均有统计学意义(均P<0.05)。3.夹层组27例存活,失访4例。体格发育异常9例,3例合并眼部疾病、1例智力发育落后;均未行基因检测。结论妊娠合并AD孕妇分娩新生儿体格发育落后,并发症发生率高,生存质量降低,需更长久的生长发育监测及随访。

Objective To explore the short-term and long-term effects of pregnancy with aortic dissection(AD)on newborns.Methods In this retrospective cohort study,31 live births of pregnant women with AD admitted to Beijing Anzhen Hospital,Capital Medical University from June 2010 to June 2022 were selected as the AD group.Among them,19 preterm births were in the preterm AD group.Additionally,100 neonates delivered by pregnant women without pregnancy complications were selected as the normal control group,and 50 preterm infants delivered by pregnant women without pregnancy complications were selected as the preterm control group during the same period.The differences between the AD group and the normal control group,and between the preterm AD group and the preterm control group were compared using the independent samples t-test,Chi-square test,and Fisher′s exact test.Patients in the AD group were followed up for 5 years.Results(1)The incidence rates of small for gestational age(SGA)(12.90%vs.1.00%),neonatal respiratory distress syndrome(NRDS)(16.13%vs.2.00%),digestive tract hemorrhage(16.13%vs.1.00%),nervous system disease(16.13%vs.1.00%),multiple organ dysfunction syndrome(MODS)(12.90%vs.0),premature infant(61.29%vs.5.00%),asphyxia(35.48%vs.1.00%),cardiopulmonary resuscitation(64.52%vs.1.00%),respiratory support(38.71%vs.2.00%),transfer to the department of pediatrics within 24 hours of birth(90.32%vs.13.00%),caesarean section(100%vs.25.00%),and low birth weight infant(38.71%vs.2.00%)in the AD group were significantly higher than those in the normal control group,while the gestational age[(34.90±2.80)weeks vs.(38.87±1.50)weeks],length[(45.65±3.56)cm vs.(50.17±0.81)cm],and weight[(2456.77±634.02)g vs.(3383.90±413.05)g]were significantly less than those in the normal control group,and the differences were statistically significant(all P<0.05).(2)The gestational age[(33.26±2.31)weeks vs.(34.80±1.29)weeks],length[(43.89±3.36)cm vs.(46.64±2.89)cm],and weight[(2158.95±558.92)g vs.(2418.20±431.20)g]in the preterm AD group were less than those in the preterm control group,while the incidence rates of NRDS(26.32%vs.4.00%),digestive tract hemorrhage(21.05%vs.4.00%),nervous system disease(26.32%vs.6.00%),MODS(21.05%vs.2.00%),caesarean section(100%vs.52.00%),cardiopulmonary resuscitation(73.68%vs.8.00%),respiratory support(63.16%vs.10.00%),and asphyxia(47.37%vs.2.00%)were significantly higher than those in the preterm control group,and the differences were statistically significant(all P<0.05).(3)Twenty-seven cases in the AD group survived,and 4 cases were lost to follow-up.Among them,9 cases had abnormal physical development,3 cases had eye disease,and 1 case was mentally retarded.None of them underwent genetic detection.Conclusions Neonates born to mothers with AD in pregnancy have poor physical development,high incidence of complications,and reduced quality of life,and need long-term monitoring and follow-up in their growth and development.