CAJ | 학술논문

目的：探讨合并心脏病的孕产妇发生心力衰竭的危险因素。方法回顾分析2008年1月至2013年12月于内江市第一人民医院住院的340例合并心脏病的孕产妇（以下简称“心脏病孕产妇”）的临床资料，以孕产期发生心力衰竭患者为观察组，同期未发生心力衰竭的心脏病孕产妇为对照组。采用单因素和多因素Logistic逐步回归法分析心脏病孕产妇发生心力衰竭的危险因素。结果340例心脏病孕产妇中先天性心脏病132例（38.8%）、风湿性心脏瓣膜病86例（25.3%）、心律失常63例（18.5%）、高血压心脏病33例（9.7%）、围生期心肌病26例（7.6%）。65例（19.1%）患者发生心力衰竭，4例（1.2%）患者死亡。多因素Logistic逐步回归分析：年龄≥35岁、孕前NYHA心功能分级≥Ⅱ级、肺动脉压力＞50 mmHg（1 mmHg=0.133 kPa）、基础心率＞100次/min、孕前发生心脏事件是心脏病孕产妇发生心力衰竭的独立危险因素，而孕前咨询和产前规律检查是其保护性因素。结论心脏病孕产妇发生心力衰竭受多种因素影响，在临床工作中应针对相应危险因素给予积极的干预措施，以减少心力衰竭的发生。
목적：탐토합병심장병적잉산부발생심력쇠갈적위험인소。방법회고분석2008년1월지2013년12월우내강시제일인민의원주원적340례합병심장병적잉산부（이하간칭“심장병잉산부”）적림상자료，이잉산기발생심력쇠갈환자위관찰조，동기미발생심력쇠갈적심장병잉산부위대조조。채용단인소화다인소Logistic축보회귀법분석심장병잉산부발생심력쇠갈적위험인소。결과340례심장병잉산부중선천성심장병132례（38.8%）、풍습성심장판막병86례（25.3%）、심률실상63례（18.5%）、고혈압심장병33례（9.7%）、위생기심기병26례（7.6%）。65례（19.1%）환자발생심력쇠갈，4례（1.2%）환자사망。다인소Logistic축보회귀분석：년령≥35세、잉전NYHA심공능분급≥Ⅱ급、폐동맥압력＞50 mmHg（1 mmHg=0.133 kPa）、기출심솔＞100차/min、잉전발생심장사건시심장병잉산부발생심력쇠갈적독립위험인소，이잉전자순화산전규률검사시기보호성인소。결론심장병잉산부발생심력쇠갈수다충인소영향，재림상공작중응침대상응위험인소급여적겁적간예조시，이감소심력쇠갈적발생。
Objective To investigate the risk factors for heart failure in pregnant women with heart disease. Methods A retrospective analysis was made from 340 cases of pregnant women with heart disease in our hospital from January 2008 to December 2013. The pregnant women who presented heart failure were categorized in the observation group (n=65), and others were in the control group (n=275). Data was used to analyze by univariate and multivariate logistic regression for heart failure in pregnant women with heart disease. Results The total 340 cases of heart disease included 132(38.8%) of congenital heart disease, 86(25.3%) of rheumatic heart disease, 63(18.5%) of arrhythmia, 33(9.7%) of hypertensive heart disease and 26(7.6%) of peripartum cardiomyopathy. 65 cases (65/340, 19.1%) presented with heart failure, there were 4 cases resulted in death (1.2%). Multivariate logistic regression analysis showed that age≥35, the baseline parameters of New York Heart Academy (NYHA)≥Ⅱ, pulmonary artery pressure>50 mmHg (1 mmHg=0.133 kPa), baseline heart rate>100 bpm, cardiac events occurred before pregnancy were the independent risk factors for heart failure. Prenatal counseling and antenatal examination were the protective factors for heart failure. Conclusions There are a variety of influencing factors for the heart failure in pregnant women with heart disease. It is necessary to take targeted intervention measures in response to the influencing factors so as to reduce the development of heart failure.