2022 年第 12 期 第 17 卷

不同类型先天性心脏病术后妊娠与母儿结局相关性分析

Correlation of postoperative pregnancy to maternal and fetal outcomes of patients with different types of congenital heart disease

作者：龚静1张昕1乔玲玲2马嘉为3李秀珍4张军1

英文作者：Gong Jing1 Zhang Xin1 Qiao Lingling2 Ma Jiawei3 Li Xiuzhen4 Zhang Jun1

单位：1首都医科大学附属北京安贞医院妇产科，北京100029；2河北省承德市滦平县医院手术室，承德068250；3辽宁省盘锦辽油宝石花医院重症监护病房，盘锦124000；4河北省承德市双滦区人民医院重症监护病房，承德067000

英文单位：1Department of Obstetrics and Gynecology  Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Operation Room Luanping County Hospital of Chengde City Hebei Province Chengde 068250 China; 3Intensive Care Unit Panjin Liaoyou Baoshihua Hospital Liaoning Province Panjin 124000 China; 4Intensive Care Unit People′s Hospital of Shuangluan District Chengde City Hebei Province Chengde 067000 China

关键词：先天性心脏病；妊娠；母儿结局

英文关键词：Congenitalheartdisease;Pregnancy;Maternalandinfantoutcomes

• 摘要：

• 目的  探讨不同类型先天性心脏病（CHD）术后妊娠与母儿结局的相关性。方法  回顾性分析2010年1月至2020年1月于首都医科大学附属北京安贞医院妇产科分娩的妊娠合并CHD术后304例患者的临床资料。依据心脏病类型将患者分为简单CHD组（156例）和复杂CHD组（148例），分别对患者基本情况（年龄、住院天数）、CHD类型和数量、心功能分级、心脏病妊娠风险等级、分娩方式、围产儿基本情况（出生孕周、新生儿体质量、身长、早产率）进行统计，并分析CHD术后妊娠与母儿结局的相关性。结果  简单CHD组年龄(28±4)岁，住院天数(8±6)d，复杂CHD组年龄(28±4)岁，住院天数(8±4)d。室间隔缺损、房间隔缺损和动脉导管未闭占简单CHD组总人数的83.3%（130/156），其他心脏病类型共占16.7%（26/156）。法洛四联症、房间隔缺损合并室间隔缺损占复杂CHD组总人数的31.8%（47/148）、其他各种类型的复杂CHD基本呈均匀分布，1～5例不等，占比变化范围为0.7%～3.4%。简单CHD组和复杂CHD组心功能Ⅰ～Ⅱ级占比分别为92.9%（145/156）和87.2%（129/148），Ⅲ～Ⅳ级的占比分别为7.1%（11/156）和12.8%（19/148）。简单CHD组妊娠风险等级Ⅰ～Ⅱ级患者占比最高，复杂CHD组Ⅳ～Ⅴ级患者占比最高，Ⅲ级患者2组比例相当。简单CHD组无死亡，复杂CHD组死亡2例，2组死亡率差异无统计学意义（P＞0.05）。2组阴道分娩率比较差异无统计学意义（P＞0.05）。复杂CHD组新生儿出生孕周小于简单CHD组［（37.7±2.1）周比（38.7±1.8）周］，差异有统计学意义（P<0.05）。2组新生儿出生体质量、新生儿身长比较差异均无统计学意义（均P>0.05）。复杂CHD组早产率高于简单CHD组（P<0.001），2组胎儿异常率差异无统计学意义（P＞0.05）。结论  复杂CHD术后妊娠孕产妇的心脏病类型和数量远多于简单CHD孕产妇。不同类型CHD术后妇女围产期母儿预后基本无差异，手术干预在改善CHD妇女妊娠的预后方面起到积极的促进作用。

• Objective  To investigate the correlation of postoperative pregnancy to maternal and fetal outcomes of patients with different types of congenital heart disease(CHD). Methods  From January 2010 to January 2020, clinical data of 304 pregnant patients delivered in Beijing Anzhen Hospital, Capital Medical University were collected for retrospective analysis. All patients were pregnant after CHD surgery, and they were divided into simple CHD group (156 cases) and complex CHD group (148 cases) according to the type of heart disease. The basic information of patients (age, length of stay), type and quantity of CHD, cardiac function classification, risk level of heart disease pregnancy, delivery mode, and basic information of perinatal infants (gestational age, neonatal body mass, height, premature delivery rate) were statistically analyzed, and the correlation among them was analyzed. Results  The age of simple CHD group was (28±4) years, and the length of stay was (8±6) d. The age of complex CHD group was (28±4) years, and the length of stay was (8±4) d. Ventricular septal defect, atrial septal defect and patent ductus arteriosus accounted for 83.3%(130/156) of the total simple CHD group, and other types of heart disease accounted for 16.7%(26/156). Tetralogy of Fallot and atrial septal defect complicated with ventricular septal defect accounted for 31.8%(47/148) of the total complex CHD group. The distribution of other types of complex CHD was basically uniform, ranging 1-5 cases, accounting for 0.7%-3.4%. In simple CHD group and complex CHD group, 92.9%(145/156) and 87.2%(129/148) of cardiac function in patients were grading Ⅰ-Ⅱ, and 7.1%(11/156) and 12.8%(19/148) were grading Ⅲ-Ⅳ, respectively. The proportion of patients with pregnancy risk grading Ⅰ-Ⅱ was the highest in simple CHD group. The proportion of patients with pregnancy risk grading Ⅳ-Ⅴwas the highest in complex CHD group, and the proportion of patients with grading Ⅲ was similar between the two groups. There was no death in simple CHD group and 2 patients death in complex CHD group. There was no significant difference in mortality between the two groups(P>0.05). There was no significant difference in vaginal delivery rate between the two groups(P>0.05). The gestational weeks of newborns in complex CHD group were less than those in simple CHD group［(37.7±2.1)weeks vs (38.7±1.8)weeks］(P<0.05). There were no significant differences in neonatal body mass and height between the two groups(both P>0.05). The premature delivery rate in complex CHD group was higher than that in simple CHD group(P<0.001), and there was no significant difference in the fetal abnormality rate between the two groups(P>0.05). Conclusions  The type and number of heart disease in pregnant women with complex CHD after surgery are more than those with simple CHD. The perinatal maternal and fetal outcomes of women with different types of CHD have no difference essentially. Surgical intervention for women with CHD plays an active role in improving pregnancy outcomes.