妊娠合并严重心脏病188例临床资料分析

A clinical analysis of 188 cases of pregnancy complicated with critically heart disease

目的:通过对进入产科重症监护室(intensive care unit,ICU)的妊娠合并严重心脏病患者临床资料的分析,探讨妊娠合并严重心脏病患者妊娠结局的相关影响因素。方法:对2009年7月至2013年3月间,进入四川大学华西第二医院产科ICU的188例妊娠合并心脏病的孕产妇的临床资料进行回顾性分析。结果:4年间华西第二医院产科收治妊娠合并心脏病患者共619例,其中188例(30.37%)危重者进入产科ICU,占同期进入ICU的产科危重症(480例)的39.17%;188例严重心脏病患者年龄(28.45±6.08)岁,孕周(36.03±4.19)周;23例(12.23%)为本院规律产检,61例(32.45%)从未行产检,5例死亡患者均未规律产检。心脏病的诊断时间39.89%为孕前,25.54%为孕期,34.57%为入院时。188例严重心脏病患者中心脏病类型以先天性心脏病(80例,42.55%)、风湿性心脏病(45例,23.94%)及心律失常(20例,10.64%)最常见,并发症以肺动脉高压(51例,27.13%)、心律失常(47例,25.00%)、心力衰竭(30例,15.96%)为主。188例严重心脏病患者入住ICU天数为(2.40±1.35)d,总住院天数为(8.05±4.05)d;164例(87.23%)心功恢复为I^II级出院,5例(2.66%)死亡;151例(80.32%)行多科会诊,34例(18.09%)行中心静脉穿刺以监测中心静脉压(central venous pressure,CVP),21例(11.17%)使用呼吸机,11例(5.85%)行高级生命支持[心肺复苏(cardiopulmonary resuscitation,CPR)8例+电除颤3例]。结论:妊娠合并严重心脏病是孕产妇进入产科ICU的首要原因,严重危害孕产妇生命。其中以先天性心脏病、风湿性心脏病和心律失常最常见。多科协作、重症监护是改善危重患者结局的重要措施;加强孕前、产前保健及围产期处理是降低孕产妇死亡率的关键。

Objective:To investigate the factors that affect the outcome of pregnancies complicated with critically heart disease admitt ed to obstetric Intensive Care Unit(ICU).Methods:A retrospective study was conducted for 188 pregnant and postpartum patients complicated with heart disease who were admitted to the ICU in West China Second University Hospital from July 2009 to March 2013.Results:During the 4 years,there were 619 cases of pregnancy complicated with heart disease hospitalization.Among them,188(30.37%) patients complicated with severe heart disease were admitted to the ICU,accounting for 39.17% of the total ICU admission(480);the mean maternal age was(28.45±6.08) years old and the mean gestational time was(36.03±4.19) weeks.23(12.23%) patients received regular antenatal care in our hospital.61(32.45%) patients never received antenatal care before hospitalization.Among them,5 patients were dead.The ratio for diagnosis of heart disease before pregnancy,during pregnancy and after admission were 39.89%,25.54% and 34.57%,respectively;the most common heart diseases during pregnancy were congenital cardiac disease(80,42.55%) and rheumatic heart disease(45,23.94%) followed by arrhythmias(20,10.64%).The most common complication were pulmonary arterial hypertension(51,27.13%),arrhythmias(47,25.00%) and severe heart failure(30,15.96%);the cardiac function of 164(87.23%) patients was at stage I–II and 5(2.66%) patients died when discharged from hospital.151(80.32%) patients received multidisciplinary consultation and 34(18.09%) used central venous catheterization to control central venous pressure(CVP).21(11.17%) patients required mechanical ventilation.11(5.85%) patients required emergency life support(cardiopulmonary resuscitation 9 + electric defibrillation 3).Conclusion:Pregnancy complicated with heart disease is the leading reason for admission to ICU.The congenital cardiac disease,rheumatic heart disease and arrhythmias are the main heart diseases during pregnancy.Multidisciplinary cooperation and intensive care are the key measures to improve the outcomes of patients with critically illness.It is very important for reduction of the maternal mortality rate through strengthening preconception care and antenatal care.