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目的:探讨妊娠合并心脏病患者发生围产儿并发症的主要危险因素,在此基础上拟定风险指数测定。方法:回顾分析1993年1月至2010年8月在我院产科心脏病监护中心分娩的1725例妊娠合并心脏病患者的临床资料。采用Logistic回归分析预测心脏病孕产妇发生围产儿并发症的独立危险因素,并计算围产儿风险指数。结果:(1)妊娠合并心脏病患者主要的心脏病类型为先天性心脏病529例(30.67%)、风湿性心脏病151例(8.75%)、心律失常662例(38.38%)、心肌疾病327例(18.96%)和妊娠期高血压性心脏病53例(3.07%)。(2)围产儿并发症主要为早产儿215例(12.46%)、小于胎龄儿90例(5.22%)、新生儿窒息43例(2.49%)及围产儿死亡56例(3.25%)。(3)心脏病孕产妇发生围产儿并发症的独立危险因素为双胎妊娠(P=0.000)、孕前发生过心脏事件(心衰、严重心律失常、心源性休克)(P=0.003)、心功能>Ⅱ级(P=0.000)、未手术纠正的紫绀型心脏病(P=0.000)、氧饱和度<90%(P=0.003)、肺动脉高压≥50mmHg(P=0.000)、左心梗阻(P=0.009)。(4)每个独立危险因素占1分。0、1、2、3、≥4分的患者发生围产儿并发症的概率分别为9.52%、40.00%、69.70%、85.29%和93.33%。结论:妊娠合并心脏病可导致围产儿严重不良结局,妊娠合并心脏病患者发生围产儿并发症的风险可由风险指数来判定。
Objective: To explore the main risk factors of perinatal complications in pregnant women with heart disease, and then to establish the risk index. Methods: A retrospective analysis of clinical data of 1725 pregnant women with heart disease who were delivered in our obstetric cardiology care center from January 1993 to August 2010 was retrospectively analyzed. Logistic regression analysis was used to predict the independent risk factors of perinatal complications in pregnant women with heart disease and to calculate the perinatal risk index. Results: (1) The main types of heart disease in pregnancy complicated with heart disease were 529 cases (30.67%) of congenital heart disease, 151 cases (8.75%) of rheumatic heart disease, 662 cases of arrhythmia (38.38%), Cases (18.96%) and hypertensive heart disease in pregnancy in 53 cases (3.07%). (2) Perinatal complications mainly included 215 cases (12.46%) of premature children, 90 cases (5.22%) of gestational age, 43 cases (2.49%) of neonatal asphyxia and 56 cases (3.25%) of perinatal death. (3) The independent risk factors of perinatal complications of heart disease pregnant women were twin pregnancy (P = 0.000), cardiac events (heart failure, severe arrhythmia, cardiogenic shock) before pregnancy (P = 0.003) Heart function> grade II (P = 0.000), no surgical correction of cyanotic heart disease (P = 0.000), oxygen saturation <90% (P = 0.003), pulmonary hypertension 50 mmHg (P = 0.009). (4) 1 point for each independent risk factor. The probabilities of perinatal complications in patients with 0, 1, 2, 3, and 4 points were 9.52%, 40.00%, 69.70%, 85.29% and 93.33%, respectively. Conclusion: Pregnancy complicated by heart disease can lead to serious adverse perinatal outcome. The risk of perinatal complications in pregnant women with heart disease can be judged by risk index.