妊娠合并心脏病109例分析及初始NT-proBNP检测的临床价值研究

发布时间：2019-05-13 15:10

【摘要】：目的:了解我院急诊科接诊的妊娠合并心脏病患者的类型分布并探讨初始NT-pro BNP检测在妊娠合并心脏病患者心功能状态和预后评估中的价值。方法:回顾性收集2013年1月~2016年12月河北医科大学第二医院急诊科接诊的109例妊娠合并心脏病患者的临床资料,整理数据并用SPSS21.0统计学软件对数据进行统计与分析。结果:1我院急诊科接诊的妊娠合并心脏病患者以结构性心脏病为主(包括37例先天性心脏病和5例风湿性心脏病,共占38.5%),其次为妊娠期高血压性心脏病(40例,36.7%),排第三位的为围产期心脏病(10例,9.2%),其他各种类型心脏病占15.6%。2 42例结构性心脏病(37例先天性心脏病和5例风湿性心脏病)患者中曾行心脏手术治疗的有13例(30.9%),主要为房/室间隔缺损修补术和心脏瓣膜置换术,其中心功能Ⅱ级11例,心功能Ⅲ、Ⅳ级各1例。心脏手术能改善孕期患者心功能状态,与非手术组相比,差异有统计学意义(P0.05)。3 109例患者中活产94例,死产15例,心功能Ⅲ-Ⅳ级组的死产率高于心功能Ⅱ级组(P0.01);活产患者中,早产35例,足月产59例,心功能Ⅲ-Ⅳ级组的早产率高于心功能Ⅱ级组(P0.01);活产患者中,剖宫产80例,经阴道分娩14例,心功能Ⅲ-Ⅳ级的剖宫产率高于心功能Ⅱ级组(P0.01);心功能Ⅲ-Ⅳ级组的新生儿体重、出生5min Apgar评分低于心功能Ⅱ级组(P0.05)。4比较心功能Ⅱ、Ⅲ、Ⅳ级患者初始血浆NT-pro BNP浓度,发现各组间存在明显差异(P0.001),对患者心功能分级和对应的NT-pro BNP散点图添加回归模型拟合线,患者血浆NT-pro BNP浓度与心功能分级呈正相关(n=96,R2=0.542,P0.05)。5妊娠期高血压性心脏病组和结构性心脏病组各组内比较血浆NTpro BNP浓度,心功能Ⅲ-Ⅳ级组NT-pro BNP水平明显高于心功能Ⅱ级组(P0.01);比较不同类型心脏病患者初始血浆NT-pro BNP浓度,结构性心脏病组与妊娠期高血压性心脏病组相应亚组间比较均无显著性差异(P0.05),围产期心肌病组血浆NT-pro BNP水平高于妊娠期高血压性心脏病组和结构性心肌病组(P0.05)。6绘制受试者工作特征曲线,NT-pro BNP判断结构性心脏病患者预后的曲线下面积为0.896,95%置信区间为(0.799,0.992),最佳截断值为1474.34pg/m L,该点对应的敏感度为88.9%,特异度为84.8%,约登指数为0.737。结论:1于我院急诊科就诊的妊娠合并心脏病患者主要以结构性心脏病、妊娠期高血压性心脏病和围产期心肌病为主,死亡患者主要以结构性心脏病患者为主,行相关心脏手术治疗能改善结构性心脏病患者妊娠后的心功能状态。2妊娠合并心脏病患者心功能状态与围生儿结局密切相关,心功能Ⅲ-Ⅳ级患者出现围生儿不良妊娠结局的机率高于心功能Ⅱ级患者。3血浆NT-pro BNP浓度在评估妊娠合并心脏病患者心功能时有重要的临床价值,但在应用NT-pro BNP评估患者心功能状态及预测患者预后时应结合具体心脏病类型进行判断。
[Abstract]:Objective: to investigate the type distribution of pregnancy complicated with heart disease in emergency department of our hospital and to explore the value of initial NT-pro BNP detection in the evaluation of cardiac function and prognosis in pregnant patients with heart disease. Methods: the clinical data of 109 pregnant patients with heart disease received by the Emergency Department of the second Hospital of Hebei Medical University from January 2013 to December 2016 were collected retrospectively. the data were collected and analyzed by SPSS21.0 statistical software. Results: 1structural heart disease was the main cause of pregnancy complicated with heart disease in emergency department of our hospital (including 37 cases of congenital heart disease and 5 cases of rheumatic heart disease, accounting for 38.5%), followed by hypertensive heart disease during pregnancy (40 cases). 36.7%), the third largest was postpartum heart disease (10 cases, 9.2%). Other types of heart disease accounted for 15.6%. Among 42 patients with structural heart disease (37 congenital heart disease and 5 rheumatic heart disease), 13 (30.9%) had undergone cardiac surgery. The main results were atrial / ventricular septum defect repair and cardiac valve replacement. There were 11 cases of central function grade 鈪，

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