CAJ | 학술논문

目的分析妊娠合并艾森曼格综合征(Eisenmenger syndrome)患者的妊娠结局,探讨其围产期处理方法,降低此类孕产妇的病死率.方法对2001年1月1日至2009年12月31日在首都医科大学附属北京安贞医院分娩的23例妊娠合并艾森曼格综合征患者的发病孕周、心脏原发病、肺动脉高压、氧饱和度和心功能进行回顾性分析.统计学方法采用x2检验或Fisher精确概率法.结果 (1)孕周在15～38周之间的23例妊娠合并艾森曼格综合征的孕妇,孕中期11例,孕晚期12例,不同发病孕周者肺动脉高压的程度、心功能及预后差异无统计学意义(P＞0.05).C2)在4种心脏原发病中,室间隔缺损的患者最多(65.2％,15/23),妊娠后出现心功能下降程度最重,其中心功能Ⅳ级的比例占73.3％(11/15),重度肺动脉高压的比例占20.0％(3/15).不同原发病患者妊娠后心功能下降程度差异具有统计学意义(P＜0.05).(3)肺动脉高压孕妇中,轻度7例(30.4％),中度12例(52.2％),重度4例(17.4％).不同肺动脉高压程度者产后心衰发生率及病死率差异有统计学意义(P＜0.05),其中重度肺动脉高压患者妊娠结局最差,4例均死亡,病死率4/4.(4)不同程度氧饱和度患者的围产儿病死率、早产率、自然流产率差异均有统计学意义(P＜0.05).氧饱和度下降到重度时,围产儿病死率最高,为5.3％(1/19),早产率为84.2％(16/19),自然流产率为10.5％(2/19).结论妊娠合并艾森曼格综合征患者妊娠后应严密监测,积极降低患者的肺动脉高压,及时终止妊娠,是提高艾森曼格综合征孕产妇围产期安全性的关键.
목적 분석임신합병애삼만격종합정(Eisenmenger syndrome)환자적임신결국,탐토기위산기처리방법,강저차류잉산부적병사솔.방법 대2001년1월1일지2009년12월31일재수도의과대학부속북경안정의원분면적23례임신합병애삼만격종합정환자적발병잉주、심장원발병、폐동맥고압、양포화도화심공능진행회고성분석.통계학방법채용x2검험혹Fisher정학개솔법.결과 (1)잉주재15～38주지간적23례임신합병애삼만격종합정적잉부,잉중기11례,잉만기12례,불동발병잉주자폐동맥고압적정도、심공능급예후차이무통계학의의(P＞0.05).C2)재4충심장원발병중,실간격결손적환자최다(65.2％,15/23),임신후출현심공능하강정도최중,기중심공능Ⅳ급적비례점73.3％(11/15),중도폐동맥고압적비례점20.0％(3/15).불동원발병환자임신후심공능하강정도차이구유통계학의의(P＜0.05).(3)폐동맥고압잉부중,경도7례(30.4％),중도12례(52.2％),중도4례(17.4％).불동폐동맥고압정도자산후심쇠발생솔급병사솔차이유통계학의의(P＜0.05),기중중도폐동맥고압환자임신결국최차,4례균사망,병사솔4/4.(4)불동정도양포화도환자적위산인병사솔、조산솔、자연유산솔차이균유통계학의의(P＜0.05).양포화도하강도중도시,위산인병사솔최고,위5.3％(1/19),조산솔위84.2％(16/19),자연유산솔위10.5％(2/19).결론 임신합병애삼만격종합정환자임신후응엄밀감측,적겁강저환자적폐동맥고압,급시종지임신,시제고애삼만격종합정잉산부위산기안전성적관건.
Objective To investigate the outcome and the management of pregnant women with Eisenmenger syndrome during perinatal period to reduce the maternal fatality rate.Methods The clinical data of 23 pregnant women with Eisenmenger syndrome admitted into Beijing Anzhen Hospital Capital Medical University from January 1st,2001 to December 31st,2009 were retrospectively analyzed.Gestational week,primary disease of the heart,pulmonary hypertension,oxygen saturation and heart function of the patients were compared with Chi-square test or Fisher's exact test.Results (1) The gestational week of 23 patients with Eisenmenger syndrome were between 15 to 38 weeks,among which 11 cases in the midterm pregnancy and 12 in the last term pregnancy.The severity of pulmonary hypertension,heart function and pregnant outcomes have no difference in patients with differeut gestational weeks (P＞0.05).(2) Ventricular septal defect (VSD) were the most common disease (65.2％,15/23) among the four primary heart diseases of the patients.The heart function of the patients with VSD decreased most severely after pregnancy,and the fatality rate of the heart function Ⅳ was up to 73.3％ (11/15).The incidence of severe pulmonary hypertension was 20.0％ (3/15).The decreasing of the heart function of the patients with different primary heart diseases were different (P＜0.05).(3) Among the pulmonary hypertension patients,there were 7 mild cases (30.4％),12 moderate cases (52.2％) and 4 severe cases (17.4％).The severity of the pulmonary hypertension of the patients correlated to the incidence of postpartum heart failure and death (P＜ 0.05).The outcomes of four patients with severe pulmonary hypertension were the worst and all were reported to be dead (4/4).(4) Oxygen saturation related to the mortality of perinatal infants,incidence of premature birth and spontaneous abortion (P＜0.05).As oxygen saturation decreased to the lowest level,the fatality rate of perinatal infants increased to the highest (5.3 ％,1/19),so did the incidence of the premature birth (84.2％,16/19) and spontaneous abortion ( 10.5％,2/19).Conclusions The key point to increase the safety of patients with Eisenmenger syndrome during perinatal period was to strengthen monitoring,decrease the pulmonary hypertension and terminate pregnancy timely.