2018 年第 12 期 第 13 卷

妊娠合并肥厚型心肌病患者的临床特征及妊娠结局

Clinical features and pregnancy outcomes of pregnant women with hypertrophic cardiomyopathy

作者：陆育秋张军

英文作者：

单位：100029首都医科大学附属北京安贞医院妇产科

英文单位：

关键词：妊娠；肥厚型心肌病；临床分析

英文关键词：

• 摘要：

• 【摘要】目的    分析妊娠合并肥厚型心肌病（HCM）患者的临床特征及妊娠结局。方法    选取2010年1月至2018年1月于首都医科大学附属北京安贞医院住院终止妊娠的HCM患者42例，回顾性分析其孕期体格检查、辅助检查(超声心动图、心电图检查)、产科处理和结局等相关资料。结果    42例患者中梗阻型12例(28.6%)，非梗阻型30例（71.4%）；美国纽约心脏病协会心功能分级Ⅰ~Ⅱ级39例（92.9%），Ⅲ~Ⅳ级 3例（7.1%）;心电图以ST-T改变为主。5例(12.0%)孕早、中期终止妊娠；进入围产期37例患者中32例(76.2%)行剖宫产术终止妊娠，5例（23.8%）自然分娩；其中33例(89.2%)为孕足月分娩，4例(10.8%)早产（孕28～36+6周）。42例孕妇均病情稳定出院。37名围生儿均存活，未发生新生儿窒息。4名早产儿中低出生体质量儿(出生体质量<2 500 g)2名，33名足月围生儿中低出生体质量儿1名（3.0%），余32名（97.0%）为正常体质量新生儿。结论    根据妊娠合并HCM孕妇情况，加强妊娠期及产褥期监护，多数患者可获得良好母儿结局。

• 【Abstract】Objective    To analyze the clinical features and pregnancy outcomes of pregnant women with hypertrophic cardiomyopathy（HCM）. Methods    Clinical data of 42 pregnant women with HCM who delivered in Beijing Anzhen Hospital, Capital Medical University from January 2010 to January 2018 were retrospectively analyzed. Physical, echocardiographic and electrocardiographic examination Results, obstetric treatments and pregnancy outcomes were analyzed. ResultThere were 12 cases(28.6%) of obstructive HCM and 30 cases（71.4%） of non-obstructive HCM; 39 cases of New York Heart Association cardiac function grading Ⅰ-Ⅱ and 3 cases（7.1%） of grading Ⅲ-Ⅳ. Electrocardiogram showed ST-T changes in most patients. Five patients(12.0%) had termination of a pregnancy during the first or second trimester; 32 patients(76.2%) had cesarean section and 5 patients（23.8%） had natural delivery; 33 patients(89.2%) had full-term delivery and 4 patients(10.8%) had premature delivery（28-36+6gestational weeks）. All 42 patients recovered well. All 37 newborns survived and no neonatal asphyxia occurred. Two premature infants had low birth weight（<2 500 g）. One full-term infant（3.0%） had low birth weight. Conclusion    Pregnant women with HCM can get a good maternal and child outcome after optional intervention during pregnancy and puerperium.