本文選題：妊娠 + 先天性心臟病　； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本研究通過(guò)回顧性分析我院收治的48例妊娠合并先天性心臟病伴肺動(dòng)脈高壓患者的臨床資料,探討妊娠合并先天性心臟病伴肺動(dòng)脈高壓對(duì)妊娠結(jié)局的影響,以及對(duì)分娩方式選擇的影響,從而為更好的指導(dǎo)臨床工作提供依據(jù)。方法:對(duì)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動(dòng)脈高壓患者的臨床資料進(jìn)行回顧性分析,按照肺動(dòng)脈壓力的高低分為3組,比較三組患者心功能分級(jí)差異及妊娠期高血壓、心衰、惡性心律失常、早產(chǎn)、低出生體重、剖宮產(chǎn)等發(fā)生情況,分析肺動(dòng)脈壓力高低對(duì)妊娠結(jié)局及分娩方式的影響。結(jié)果:(1)先天性心臟病伴肺動(dòng)脈高壓患者心臟病種類(lèi)主要以室間隔缺損和房間隔缺損為主,達(dá)78%,其次是動(dòng)脈導(dǎo)管未閉。(2)心功能分級(jí)方面:重度肺動(dòng)脈高壓組心功能分級(jí)較差,60%患者心功能為III-IV級(jí),與輕度組相比,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);心功能III-IV級(jí)患者與心功能I-II級(jí)患者相比在孕婦心衰、早產(chǎn)兒及低出生體重兒的發(fā)生率方面,差異有統(tǒng)計(jì)學(xué)差異(P0.05)。(3)心臟不良事件:先天性心臟病患者多數(shù)合并心電圖異常,6例心衰患者的心功能均為III-IV級(jí)。中重度組患者伴發(fā)妊娠期高血壓疾病的風(fēng)險(xiǎn)與輕度組相比差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(4)產(chǎn)科不良事件:重度組新生兒出生孕齡較小,中重度組新生兒平均出生體重較低,分別與輕度組相比差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(5)分娩方式:先天性心臟病伴肺動(dòng)脈高壓患者分娩方式以剖宮產(chǎn)為主,各組分娩方式差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),麻醉方式主要以腰硬聯(lián)合麻醉為主。結(jié)論:先天性心臟病患者心臟缺損仍以間隔缺損為主,隨著肺動(dòng)脈壓力的增高,患者心功能越差,孕婦心衰、早產(chǎn)兒、低出生體重兒等發(fā)生率越高,臨床醫(yī)師應(yīng)該對(duì)這類(lèi)患者給予高度的重視,及早發(fā)現(xiàn)潛在的風(fēng)險(xiǎn),并做好相應(yīng)的預(yù)防措施;就分娩方式而言,雖然目前多主張剖宮產(chǎn)術(shù),但對(duì)于肺動(dòng)脈壓輕中度升高,心功能正常,軟產(chǎn)道條件好的孕婦,臨床醫(yī)師應(yīng)該幫助孕婦樹(shù)立自然分娩的信心,給予孕婦充分的經(jīng)陰道試產(chǎn)的機(jī)會(huì)。
[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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R714.252

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