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目的:探讨妊娠合并心脏病患者不同心功能状态对母儿的影响。方法:收集陕西省人民医院1993年10月—2010年10月间收治的124例妊娠合并心脏病患者的临床资料进行回顾性分析,对比2000年前与2000年以后妊娠期心脏病在发病种类上的不同;比较心功能Ⅰ,Ⅱ级与Ⅲ,Ⅳ级两组患者,发生孕产妇各种并发症以及新生儿在孕周、体重、围产儿患病率等方面的差别。结果:妊娠合并心肌炎、心肌炎后遗症及不明原因的心律失常的发生率最高,为37.5%,其次为先天性心脏病(21.9%);先天性心脏病手术后心功能良好者,妊娠结局明显好于未行手术治疗者(P<0.05);心功能Ⅲ,Ⅳ级孕产妇的并发症发生率和死亡率及围生儿窘迫、早产、低体重和新生儿患病率显著高于Ⅰ,Ⅱ级心功者(P<0.05)。结论:近年来妊娠合并心肌炎、心肌炎后遗症及不明原因的心律失常的发生率有所上升,而风湿性心脏病和围产期心肌病的发生率有所下降;先天性心脏病患者宜早诊断、早手术治疗,可耐受妊娠和分娩,发生肺动脉高压者不适于妊娠;重视孕期检查,妇产科、心脏科、麻醉科及新生儿科医生共同协作,以减少心衰的发生和母儿患病率。
Objective: To investigate the effect of different cardiac function status in pregnant women with heart disease on mother and child. Methods: The clinical data of 124 pregnant women with heart disease admitted in Shaanxi Provincial People’s Hospital from October 1993 to October 2010 were retrospectively analyzed. The incidence of heart disease in pregnancy after 2000 and 2000 was compared The differences between the two groups of patients with cardiac function Ⅰ, Ⅱ and Ⅲ, Ⅳ levels in pregnancy, maternal complications and gestational age, body weight and perinatal prevalence were compared. Results: The incidence of myocarditis, myocarditis sequelae and unexplained arrhythmia in pregnancy was the highest (37.5%), followed by congenital heart disease (21.9%). The cardiac function after pregnancy was significantly better than that of congenital heart disease The morbidity and mortality of complication and perinatal distress, preterm birth, low birth weight and neonatal morbidity of Ⅲ, Ⅳ grade pregnant women with cardiac function were significantly higher than those of Ⅰ and Ⅱ grades Heart failure (P <0.05). Conclusion: In recent years, the incidence of myocarditis, myocarditis sequelae and unexplained arrhythmia in pregnancy has risen, while the incidence of rheumatic heart disease and perinatal cardiomyopathy has decreased. Patients with congenital heart disease should be diagnosed early, Early surgical treatment can be tolerated pregnancy and childbirth, those who develop pulmonary hypertension are not suitable for pregnancy; emphasis on pregnancy check-ups, obstetrics and gynecology, cardiology, anesthesiology and neonatology physicians work together to reduce the incidence of heart failure and maternal and child illness rate.