2024 年第 11 期 第 19 卷

二尖瓣人工机械瓣膜置换术后孕妇临床特征及妊娠结局分析

The clinical characteristics and pregnancy outcomes analysis of pregnant women after mitral valve replacement with mechanical prosthetic valves

作者：牛宝荣谷孝艳王月丽杨旭何怡华

英文作者：Niu Baorong Gu Xiaoyan Wang Yueli Yang Xu He Yihua

单位：首都医科大学附属北京安贞医院心脏超声医学中心心血管疾病精准医学北京实验室胎儿心脏病母胎医学研究北京市重点实验室，北京100029

英文单位：Cardiac  Ultrasound Medical Center Beijing Anzhen Hospital Capital Medical University Beijing Laboratory of Cardiovascular Disease Precision Medicine Beijing Key Laboratory of Maternal Fetal Medicine Research on Fetal Heart Disease Beijing 100029 China

关键词：妊娠；二尖瓣人工机械瓣膜置换术后；母胎结局

英文关键词：Pregnancy;Mitralvalvereplacementwithmechanicalprostheticvalves;Maternal-fetaloutcomes

• 摘要：

• 目的 分析二尖瓣人工机械瓣膜置换术后孕妇的临床特征及妊娠结局，为该类人群安全诊疗提供依据。方法 收集2013年1月至2023年1月首都医科大学附属北京安贞医院收治的49例二尖瓣人工机械瓣膜置换术后妊娠孕妇的临床资料进行回顾性分析。回顾性分析孕妇年龄、孕周、瓣膜置换时间、新生儿体重、国际标准化比值、分娩方式以及超声心动图的差异，总结患者的临床资料特点及妊娠结局。结果 49例孕妇年龄（31±4）岁，孕周（26±14）周，妊娠距瓣膜置换时间（8±5）年，血红蛋白（115±10）g/L，谷氨酸转氨酶（13±8）U/L ，血肌酐（45±7）μmol/L，国际标准化比值1.8±0.6，二尖瓣机械瓣膜瓣口面积为（2.4±0.6）cm2，二尖瓣机械瓣膜瓣口流速（197±49）cm/s，左心室舒张末期内径（47±5）mm，左心室射血分数（61±6）%。其中发现5例存在瓣膜功能障碍，这中间有3例孕产妇在孕中期（分别为例1孕28周、例2孕30周和例5孕19周）出现机械瓣膜卡瓣，例1孕妇28周胎儿胎死宫内，重新瓣膜置换；例2为保守双联抗血小板治疗，孕34周剖宫产，胎儿出生正常；例5在保护胎儿的情况下重新瓣膜置换，孕37周剖宫产，胎儿出生正常。结论 对于接受人工机械瓣膜置换术后的孕产妇，应制定合理的抗凝策略。由于妊娠期间生理状况的变化，抗凝方案需要不断调整。在整个妊娠过程中，应密切监测血压、心率及各项抗凝指标，并定期进行超声心动图检查。同时，应采取多学科联动的综合评估方法，确保妊娠过程中的安全性，为孕产妇提供可靠的诊疗依据，以保证母婴的安全。

• Objective To analyse the clinical characteristics and pregnancy outcomes of pregnant women after mitral valve replacement with mechanical prosthetic valves, in order to provide evidence for the safe diagnosis and treatment of this population. Methods The clinical data of 49 pregnant women after mechanical mitral valve replacement admitted to Beijing Anzhen Hospital, Capital Medical University from January 2013 to January 2023 were retrospectively analyzed. The maternal age, gestational age, valve replacement time, neonatal weight, international normalized ratio, delivery mode and echocardiography differences were retrospectively analyzed, and the clinical data characteristics and pregnancy outcomes of the patients were summarized. Results Forty-nine pregnant women were aged (31±4)years, gestational week (26±14)weeks, gestational time to valve replacement (8±5)years, hemoglobin (115±10)g/L, glutamate transaminase (13±8)U/L, blood creatinine (45±7)μmol/L, international standardized ratio 1.8±0.6, mitral mechanical valve orifice area (2.4±0.6)cm2, mitral mechanical valve orifice velocity (197±49)cm/s, left ventricular end diastolic diameter (47±5)mm, and left ventricular ejection fraction (61±6)%. Among them, 5 cases were found to have valve dysfunction, of which 3 cases had mechanical valve blockage during mid pregnancy (28 weeks in case 1, 30 weeks in case 2 and 19 weeks in case 5). Case 1 suffered fetal death at 28 weeks and underwent valve replacement. Case 2 was treated with conservative dual antiplatelet therapy and delivered by cesarean section at 34 weeks of gestation with normal birth. In case 5, valve replacement was performed to protect the fetus, and the fetus was delivered by cesarean section at 37 weeks of gestation. Conclusion A reasonable anticoagulation strategy should be developed for pregnant women after mechanical valve replacement. Due to changes in physiological conditions during pregnancy, the anticoagulation regimen needs to be continuously adjusted. During the whole pregnancy, blood pressure, heart rate and various anticoagulation indicators should be closely monitored, and echocardiography should be performed regularly. At the same time, a multidisciplinary comprehensive evaluation method should be taken to ensure the safety of pregnancy and provide reliable diagnosis and treatment basis for pregnant women to ensure the safety of mother and child.