摘要
目的探讨妊娠期及产后心脏手术的治疗方案及临床结局,以期为临床治疗提供依据。方法选择2013年1月至2020年2月福建医科大学附属协和医院收治的并经多学科会诊后妊娠期及产后行心脏外科手术的20例患者,回顾性分析这些患者的一般资料、术中情况及术后转归、妊娠结局、随访等病历资料。采用描述性分析方法对数据进行分析。结果(1)20例妊娠期及产后行心脏外科手术患者中,8例(40%)房间隔缺损伴肺动脉高压,7例(35%)急性主动脉夹层,4例(20%)心脏瓣膜病变,1例(5%)左心房黏液瘤。(2)20例心脏外科手术时间:早孕期3例(15%),中孕期9例(45%),晚孕期2例(10%),晚孕期剖宫产同时手术4例(20%),产后2例(10%)。9例(45%)在全身麻醉体外循环下手术,均未发生严重产后出血。(3)除1例急性动脉夹层患者心脏外科术后1 d呼吸循环衰竭死亡及1例心脏外科手术后失访外,余18例患者均存活,其中中孕期引产1例、晚孕期胎儿宫内死亡引产1例、剖宫产分娩14例、阴道分娩2例(均为房间隔缺损伴肺动脉高压患者,中孕期行房间隔缺损封堵术,晚孕期阴道分娩)。16例活产儿中,除1例生后1 d因肺出血及呼吸循环衰竭死亡,余均存活。结论对于需要心脏外科手术治疗的孕产妇,应多学科合作,根据病情及孕周选择恰当的手术时机及手术方式,严格的术后监护随访,以保证母婴安全。
Objective To investigate the strategies and outcomes of cardiovascular surgeries during and after pregnancy to provide evidence for clinical treatment.Methods This is a descriptive study which retrospectively analyzed the medical records including general information,intraoperative conditions,postoperative and pregnancy outcomes,and follow-up data of 20 patients who underwent cardiovascular surgeries during and after pregnancy in Fujian Medical University Union Hospital from January 2013 to February 2020.Results(1)Among the 20 patients undergoing cardiac surgery during and after pregnancy,eight(40%)had atrial septal defect with pulmonary hypertension,seven(35%)had acute aortic dissection,four(20%)had valvular disease,and one(5%)had left atrial myxoma.(2)There were three cases(15%)accepted cardiac surgery in the first trimester,nine cases(45%)in the second trimester,two cases(10%)in the third trimester,four cases(20%)in late pregnancy immediately after cesarean section and two cases(10%)during postpartum.Nine out of the 20 patients(45%)had cardiac surgery with cardiopulmonary bypass under general anesthesia,and no postpartum hemorrhage occurred.(3)Apart from one death due to respiratory and circulatory failure the day after cardiac surgery on acute aortic dissention and one lost to follow-up after cardiac surgery,all of the rest 18 patients survived,among which one terminated the pregnancy in the second trimester,one had termination in the third trimester due to intrauterine fetal death,14 ended in cesarean section and two delivered vaginally(both of them with atrial septal defect and pulmonary hypertension,underwent transcatheter closure of atrial septal defect in the second trimester and delivered vaginally in the third trimester).Except for one newborn died of pulmonary hemorrhage and respiratory and circulatory failure one day after birth,all the other 15 newborns were survived.Conclusions For pregnant women requiring cardiac surgery,multi-disciplinary consultation,appropriate treatments based on the disease condition and gestational week,and strict postoperative monitoring and follow-up are essential to ensure maternal and fetal safety.
作者
吴梅婷
周瑜
戴小福
张蕙
陈玲
Wu Meiting;Zhou Yu;Dai Xiaofu;Zhang Hui;Chen Ling(Department of Obstetrics and Gynecology,Fujian Medical University Union Hospital,Fuzhou 350001,China;Department of Cardiac Surgery,Fujian Medical University Union Hospital,Fuzhou 350001,China;Department of Cardiac Surgery(Anesthesia),Fujian Medical University Union Hospital,Fuzhou 350001,China)
出处
《中华围产医学杂志》
CAS
CSCD
北大核心
2020年第12期823-827,共5页
Chinese Journal of Perinatal Medicine
关键词
妊娠
产后
心脏外科手术
体外循环
Pregnancy
Postpartum period
Cardiac surgical procedures
Extracorporeal circulation
