CAJ | 학술논문

目的：旨在探讨麻醉相关因素对先心病孕产妇预后的影响，筛选导致其预后不良的独立危险因素。方法收集2001年1月到2011年12月广州重症孕产妇救治中心收治的诊断为妊娠合并先心病的病例110例(病例组)，随机抽取同期正常孕产妇110例作为对照；以不良心血管事件探讨先心病孕产妇的预后，应用二分类非条件Logistic回归分析，对可能与预后相关的因素分别进行单因素、多因素分析，筛选出其独立危险因素。结果先心病孕产妇的不良心血管事件发生率为18.2%，最常见是心力衰竭(15.5%)，其次是恶性心律失常(4.5%)；不良心血管事件的发生与全身麻醉[OR=5.162，95%CI(1.531，17.413)]、麻醉过程中出现低血压[OR=8.375，95%CI(1.263，55.534)]、术后留置气管导管[OR=16.750，95%CI(3.492，80.341)]有关；心功能Ⅲ级以上[OR=49.216，95%CI(8.772，276.120)]和麻醉过程中出现低血压[OR=17.853，95%CI(1.332，239.298)]是不良心血管事件发生的独立危险因素。结论先心病孕产妇的预后与全身麻醉、麻醉过程中出现低血压以及术后留置气管导管有关；先心病孕产妇的心功能较差、麻醉过程中低血压会增加出现不良心血管事件的风险。
목적：지재탐토마취상관인소대선심병잉산부예후적영향，사선도치기예후불량적독립위험인소。방법수집2001년1월도2011년12월엄주중증잉산부구치중심수치적진단위임신합병선심병적병례110례(병례조)，수궤추취동기정상잉산부110례작위대조；이불양심혈관사건탐토선심병잉산부적예후，응용이분류비조건Logistic회귀분석，대가능여예후상관적인소분별진행단인소、다인소분석，사선출기독립위험인소。결과선심병잉산부적불양심혈관사건발생솔위18.2%，최상견시심력쇠갈(15.5%)，기차시악성심률실상(4.5%)；불양심혈관사건적발생여전신마취[OR=5.162，95%CI(1.531，17.413)]、마취과정중출현저혈압[OR=8.375，95%CI(1.263，55.534)]、술후류치기관도관[OR=16.750，95%CI(3.492，80.341)]유관；심공능Ⅲ급이상[OR=49.216，95%CI(8.772，276.120)]화마취과정중출현저혈압[OR=17.853，95%CI(1.332，239.298)]시불양심혈관사건발생적독립위험인소。결론선심병잉산부적예후여전신마취、마취과정중출현저혈압이급술후류치기관도관유관；선심병잉산부적심공능교차、마취과정중저혈압회증가출현불양심혈관사건적풍험。
Objective To examine the outcomes of pregnant women with congenital heart disease (CHD) associated with impact of anesthesia, as well as to screen out the independent risk factors of adverse outcomes and explore the interaction among the risk factors. Methods We reviewed the delivery records of 110 cases with CHD (case group) that were in Obstetric Critical Care Center of Guangzhou from January 2001 to December 2011, and also 110 cases of normal pregnant women without CHD in the same hospital from January 2006 to December 2011 were randomly selected as a control group. 16 possible factors related to the maternal outcomes were analyzed by binary non-conditional Logistic regression model, to screen out the risk factors of adverse cardiac events. Results The adverse cardiac events occurred in 20 cases (18.2%) of CHD, the main events were heart failure (15.5%), followed by malignant arrhythmias (4.5%), and were related to the single-factor of general anesthesia [OR =5.162, 95%CI (1.531, 17.413)], transient hypotension during anesthetic stage [OR =8.375, 95%CI (1.263, 55.534)] or indwelling endotracheal tubes after surgery [OR=16.750, 95%CI (3.492, 80.341)]. Two independent risk factors of adverse cardiac events in CHD were NYHA (New York Heart Association) functional greater than classⅢ[OR=49.216, 95%CI (8.772, 276.120)] and hypotension after anesthesia during C-section [OR = 17.853, 95%CI (1.332, 239.298)]. Conclusions In pregnant women with CHD, the adverse cardiac events are related to the factors of general anesthesia, transient hypotension during anesthetic stage and indwelling endotracheal tubes after surgery. When delivered by C-section, patients with poor cardiac function and/or hypotension after anesthesia are at increased risk for adverse cardiac events.