CAJ | 학술논문

目的探讨心脏病孕产妇发生心脏不良事件的危险因素,为改善此类患者妊娠结局提供帮助.方法回顾性分析2004-2012年在首都医科大学附属北京安贞医院综合外科监护病房住院的围产期心脏病孕产妇的临床资料.采用单因素和多因素logistic回归分析心脏病孕产妇发生心脏不良事件的危险因素.结果 190例孕龄≥20周心脏病孕产妇入选本研究,其中先天性心脏病134例(70.5％),风湿性心脏病30例(15.8％),心肌病10例(5.3％),围生期心肌病2例(1.1％),原发性高血压性心脏病14例(7.4％).42例(22.1％)患者发生心脏不良事件.7例患者死亡,病死率3.7％.死亡原因为循环衰竭死亡4例；继发肺部感染,呼吸、循环衰竭死亡2例；风湿性心脏病二尖瓣置换术后患者,孕晚期瓣膜功能急性失调,急诊终止妊娠同时行二次换瓣术,术后因严重肺动脉高压、循环衰竭死亡l例.多因素logistic回归分析显示,孕前纽约心脏病协会心功能分级＞Ⅰ级、产前左心室射血分数＜50％、产前应用血管活性药、重度肺动脉高压[肺动脉收缩压(SPAP)＞ 80 mm Hg(l mm Hg =0.133 kPa)]是心脏病孕产妇发生心脏不良事件的独立危险因素.结论心脏病孕产妇心脏不良事件发病率高,重度肺动脉高压(SPAP ＞80 mmHg)、孕前心功能差是导致心脏病孕产妇发生心脏不良事件的主要危险因素,临床工作中应加强对此类患者的密切监护及合理治疗.
목적 탐토심장병잉산부발생심장불량사건적위험인소,위개선차류환자임신결국제공방조.방법 회고성분석2004-2012년재수도의과대학부속북경안정의원종합외과감호병방주원적위산기심장병잉산부적림상자료.채용단인소화다인소logistic회귀분석심장병잉산부발생심장불량사건적위험인소.결과 190례잉령≥20주심장병잉산부입선본연구,기중선천성심장병134례(70.5％),풍습성심장병30례(15.8％),심기병10례(5.3％),위생기심기병2례(1.1％),원발성고혈압성심장병14례(7.4％).42례(22.1％)환자발생심장불량사건.7례환자사망,병사솔3.7％.사망원인위순배쇠갈사망4례；계발폐부감염,호흡、순배쇠갈사망2례；풍습성심장병이첨판치환술후환자,잉만기판막공능급성실조,급진종지임신동시행이차환판술,술후인엄중폐동맥고압、순배쇠갈사망l례.다인소logistic회귀분석현시,잉전뉴약심장병협회심공능분급＞Ⅰ급、산전좌심실사혈분수＜50％、산전응용혈관활성약、중도폐동맥고압[폐동맥수축압(SPAP)＞ 80 mm Hg(l mm Hg =0.133 kPa)]시심장병잉산부발생심장불량사건적독립위험인소.결론심장병잉산부심장불량사건발병솔고,중도폐동맥고압(SPAP ＞80 mmHg)、잉전심공능차시도치심장병잉산부발생심장불량사건적주요위험인소,림상공작중응가강대차류환자적밀절감호급합리치료.
Objective To investigate the risk factors for postpartum cardiac events in pregnant women with heart diseases and to provide prenatal counseling for them.Methods A retrospective analysis was made in cases of pregnant women with heart diseases admitted to the surgical intensive care unit (SICU) of Anzhen Hospital from May 2004 to May 2012.Data were used to identify univariate and multivariate predictors for postpartum cardiac events.Results A total of 190 patients (≥ 20 weeks gestation) were enrolled in the study with 134 (70.5％) of congenital heart disease,30 (15.8％) of rheumatic heart disease,10 (5.3％) of cardiomyopathy,2 (1.1％) of peripartum cardiomyopathy and 14(7.4％) of hypertensive heart disease.Postpartum cardiac events were observed in 42 cases with the incidence of 22.1％.A total of 7 cases resulted in death with the mortality rate of 3.7％.Among them,5 cases were dead of circulatory collapse and pulmonary hypertensive crisis postpartum,while the other 2 cases with secondary pulmonary infection were died of respiratory and circulatory collapse.The baseline parameters of New York Heart Academy(NYHA) ＞ 1,left ventricular ejection fraction (LVEF) ＜ 50％,use of cardiac drugs and pulmonary artery hypertension(PAH) ＞ 80 mm Hg(1 mm Hg =0.133 kPa) were the independent predictors for postpartum cardiac events by univariate and multivariate logistic regression analysis.Conclusions The incidence of postpartum cardiac events is high in pregnant women with heart diseases.Pulmonary artery hypertension and heart failure are the main causes of death.