妊娠合并先天性心脏病伴肺动脉高压患者妊娠结局及分娩方式分析

发布时间：2018-05-21 20:21

本文选题：妊娠 + 先天性心脏病　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:本研究通过回顾性分析我院收治的48例妊娠合并先天性心脏病伴肺动脉高压患者的临床资料,探讨妊娠合并先天性心脏病伴肺动脉高压对妊娠结局的影响,以及对分娩方式选择的影响,从而为更好的指导临床工作提供依据。方法:对本院2012年6月至2016年6月我院收治的48例妊娠合并先心病伴肺动脉高压患者的临床资料进行回顾性分析,按照肺动脉压力的高低分为3组,比较三组患者心功能分级差异及妊娠期高血压、心衰、恶性心律失常、早产、低出生体重、剖宫产等发生情况,分析肺动脉压力高低对妊娠结局及分娩方式的影响。结果:(1)先天性心脏病伴肺动脉高压患者心脏病种类主要以室间隔缺损和房间隔缺损为主,达78%,其次是动脉导管未闭。(2)心功能分级方面:重度肺动脉高压组心功能分级较差,60%患者心功能为III-IV级,与轻度组相比,差异具有统计学意义(P0.05);心功能III-IV级患者与心功能I-II级患者相比在孕妇心衰、早产儿及低出生体重儿的发生率方面,差异有统计学差异(P0.05)。(3)心脏不良事件:先天性心脏病患者多数合并心电图异常,6例心衰患者的心功能均为III-IV级。中重度组患者伴发妊娠期高血压疾病的风险与轻度组相比差异无统计学意义(P0.05)。(4)产科不良事件:重度组新生儿出生孕龄较小,中重度组新生儿平均出生体重较低,分别与轻度组相比差异有统计学意义(P0.05)。(5)分娩方式:先天性心脏病伴肺动脉高压患者分娩方式以剖宫产为主,各组分娩方式差异无统计学意义(P0.05),麻醉方式主要以腰硬联合麻醉为主。结论:先天性心脏病患者心脏缺损仍以间隔缺损为主,随着肺动脉压力的增高,患者心功能越差,孕妇心衰、早产儿、低出生体重儿等发生率越高,临床医师应该对这类患者给予高度的重视,及早发现潜在的风险,并做好相应的预防措施;就分娩方式而言,虽然目前多主张剖宫产术,但对于肺动脉压轻中度升高,心功能正常,软产道条件好的孕妇,临床医师应该帮助孕妇树立自然分娩的信心,给予孕妇充分的经阴道试产的机会。
[Abstract]:Objective: to analyze retrospectively the clinical data of 48 cases of pregnancy complicated with congenital heart disease and pulmonary hypertension in our hospital, and to explore the effect of pregnancy complicated with congenital heart disease with pulmonary hypertension on the outcome of pregnancy. And the influence on the choice of delivery mode, so as to provide the basis for better guiding clinical work. Methods: the clinical data of 48 cases of pregnancy complicated with congenital heart disease and pulmonary hypertension in our hospital from June 2012 to June 2016 were retrospectively analyzed and divided into 3 groups according to the pulmonary artery pressure. To compare the difference of cardiac function grade and the incidence of hypertension, heart failure, malignant arrhythmia, premature delivery, low birth weight and cesarean section, and to analyze the influence of pulmonary artery pressure on pregnancy outcome and delivery mode. Results the main types of heart diseases in patients with congenital heart disease and pulmonary hypertension were ventricular septal defect (VSD) and atrial septal defect (ASD). The score of cardiac function in patients with severe pulmonary hypertension was lower than that in patients with severe pulmonary hypertension (60%) with III-IV grade, compared with the mild group, the degree of cardiac function in the patients with severe pulmonary hypertension was lower than that in the patients with severe pulmonary hypertension. The difference was statistically significant (P 0.05). The incidence of heart failure, premature infants and low birth weight infants in III-IV patients with cardiac function was higher than that in I-II patients with cardiac function. There was a significant difference in cardiac adverse events (P0.05). The heart function of 6 patients with CHF was III-IV grade in most of the patients with congenital heart disease complicated with abnormal electrocardiogram (ECG). There was no significant difference in the risk of hypertensive disorder complicating pregnancy between the moderate and severe groups compared with the mild group (P 0.05). 4) adverse obstetric events: the newborns in the severe group had lower gestational age and the average birth weight in the moderate to severe group was lower than that in the mild group. Compared with the mild group, there was significant difference between the two groups (P 0.05): cesarean section was the main mode of delivery in patients with congenital heart disease and pulmonary hypertension. There was no significant difference in delivery modes among the groups (P 0.05), but the main anaesthesia was combined spinal-epidural anesthesia. Conclusion: the main heart defect in congenital heart disease is septal defect. With the increase of pulmonary artery pressure, the worse the heart function, the higher the incidence of heart failure in pregnant women, premature infants, low birth weight infants, etc. Clinicians should attach great importance to this type of patients, identify potential risks early, and take appropriate preventive measures. In terms of delivery mode, although cesarean section is currently advocated, pulmonary artery pressure is slightly and moderately elevated. For pregnant women with normal cardiac function and good conditions of soft delivery, clinicians should help pregnant women to establish confidence in natural delivery and give pregnant women full opportunities for vaginal trial delivery.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.252

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