【摘要】：目的:探討法洛四聯(lián)癥(TF)患者妊娠安全性的相關(guān)因素。方法:對(duì)上海仁濟(jì)醫(yī)院1993年1月至2015年6月收治的70例妊娠合并TF患者的臨床資料進(jìn)行回顧性分析。結(jié)果:(1)70例妊娠合并TF患者成功妊娠61例(87.1%),無(wú)孕產(chǎn)婦死亡,孕婦發(fā)生心臟并發(fā)癥主要為心力衰竭(5例,7.14%),其中孕前未行心臟矯治手術(shù)3例,心臟矯治術(shù)后仍然有結(jié)構(gòu)異常2例。(2)孕前行心臟矯治手術(shù)的TF患者(47例),其血紅蛋白(Hb)、血細(xì)胞比容(HCT)、氧飽和度(≥0.90)、氧分壓值、心臟彩色超聲檢查結(jié)果(右心室肥厚、肺動(dòng)脈狹窄、室間隔缺損的比例)均明顯優(yōu)于孕前未行手術(shù)者(23例)(P0.05)。(3)圍生兒存活61例(87.14%),足月產(chǎn)47例(67.14%)。圍生兒不良結(jié)局包括早產(chǎn)14例(20.00%),小于胎齡兒14例(20.00%),新生兒窒息2例(2.86%),新生兒心臟畸形3例(4.29%),新生兒死亡1例(1.43%),治療性流產(chǎn)8例(11.43%)。(4)孕前手術(shù)矯正者的足月產(chǎn)率、分娩天數(shù)、新生兒出生體質(zhì)量及治療性流產(chǎn)、小于胎齡兒、新生兒心臟畸形的發(fā)生率均明顯優(yōu)于孕前未手術(shù)者(P0.05)。(5)氧飽和度0.90是預(yù)測(cè)TF患者及其圍生兒不良結(jié)局的獨(dú)立危險(xiǎn)因素(P0.05)。結(jié)論:妊娠合并TF可導(dǎo)致孕產(chǎn)婦及圍生兒不良結(jié)局,孕前行心臟矯治手術(shù)可改善母體妊娠情況及母兒結(jié)局。孕期應(yīng)重視對(duì)孕婦氧飽和度及Hb、HCT和心臟彩超檢查指標(biāo)的監(jiān)測(cè)。未手術(shù)矯正或者心臟矯治術(shù)后仍然有結(jié)構(gòu)異常者要嚴(yán)格掌握妊娠指征。
[Abstract]:Objective: to investigate the risk factors of pregnancy safety in patients with tetralogy of Fallot (TF). Methods: the clinical data of 70 cases of pregnancy complicated with TF in Shanghai Renji Hospital from January 1993 to June 2015 were retrospectively analyzed. Results: (1) there were 61 cases (87.1%) of successful pregnancy in 70 cases of pregnancy complicated with TF. There was no maternal death. Heart failure occurred mainly in 5 cases (7.14%). There were still 2 cases of abnormal structure after orthopedic heart surgery. (2) 47 cases of TF patients undergoing cardiac surgery before pregnancy, their hemoglobin (Hb), hematocrit (HCT), oxygen saturation (鈮，

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