妊娠合并心律失常275例临床分析_临床医学论文.docVIP

妊娠合并心律失常275例临床分析_临床医学论文 妊娠合并心律失常275例临床分析_临床医学论文 作者：王妍 张龑 赵扬玉 杨孜 叶蓉华 李诗兰 魏媛 王永清 江元慧 【摘要】 目的 探讨妊娠合并心律失常对妊娠结局的影响。 方法 对北京大学第三医院1993年1月～2009年6月间妊娠合并心律失常275例住院分娩患者的临床资料进行回顾性分析。 结果 妊娠合并心律失常以窦性心动过速最为常见，占48.7 %(134/275)，其次为房性或室性期前收缩和预激综合征，分别占29.5 %(81/275)和13.8 %(38/275);妊娠合并心律失常中84.7 %(233/275)为无器质性心脏病，心功能为Ⅰ～Ⅱ级，15.3 %(42/275)为器质性心脏病心律失常患者;无器质性心律失常患者妊娠结局良好，无孕产妇死亡，器质性心脏病且心功能Ⅲ～Ⅳ级心律失常患者的平均分娩孕周明显缩短(0.05)，医源性早产、围生儿死亡和孕产妇死亡分别占32.3 %(11/34)、17.6 %(6/34)和5.9 %(2/34)。 结论 妊娠合并心律失常患者的妊娠结局与是否存在器质性心脏病及心功能状态密切相关;妊娠合并无器质性心律失常患者心功能较好，通过规范管理、合理治疗可以获得良好的妊娠结局;器质性心脏病心律失常心功能Ⅲ～Ⅳ级孕产妇因心脏原因致医源性早产、围生儿死亡、孕产妇死亡均明显增加。 【关键词】 妊娠; 心律失常; 心功能 　　【Abstract】 Objective To investigate the influence of cardiac arrhythmias during pregnancy on mothers and their newborns. Methods 275 cases of pregnancies complicated with cardiac arrhythmias were reviewed. Results The most common cardiac arrhythmias during pregnancy were sinus tachycardia (48.7%). This was followed by premature atrial contractions (PACs) or premature ventricular contractions (PVCs) (29.5 %), and WollfParkinsonWhite syndrome (13.8 %). 233 cases with arrhythmias were normal cardiac structure with the NYHA grading III. The remaining 42 cases were abnormal cardiac structure. The average gestational weeks of the patients with normal structure arrhythmias were significantly higher than that of the patients with abnormal cardiac structure (0.05). Perinatal mortality and medical premature delivery were more common in patients who were cardiac arrhythmias with abnormal cardiac structure than in patients with normal structure cardiac arrhythmias. Conclusion The outcome of pregnancies complicated with arrhythmias with normal cardiac structure are optimal in most patients with standard medical therapy. 　　【Key words】 Pregnancy; Cardiac arrhythmias; Cardiac function 　　妊娠合并心律失常并不少见，心律失常种类繁多、临床表现迥异，治疗方法多样。本文回顾分析本院1993年1月至2009年6月妊娠合并心律失常275例患者的临床资料，旨在探讨妊娠合并心律失常的构成比、围生期处理及其对妊娠结局的影响。 　　对象与方法 　　一、对象 　　1993年1月至2009年6月在北京大学第三医院产科住院分娩共33 650例，其中妊娠合并心律失常患者275例，占同期住院分娩总数的