【摘要】：目的:了解我院急診科接診的妊娠合并心臟病患者的類型分布并探討初始NT-pro BNP檢測在妊娠合并心臟病患者心功能狀態(tài)和預后評估中的價值。方法:回顧性收集2013年1月~2016年12月河北醫(yī)科大學第二醫(yī)院急診科接診的109例妊娠合并心臟病患者的臨床資料,整理數(shù)據并用SPSS21.0統(tǒng)計學軟件對數(shù)據進行統(tǒng)計與分析。結果:1我院急診科接診的妊娠合并心臟病患者以結構性心臟病為主(包括37例先天性心臟病和5例風濕性心臟病,共占38.5%),其次為妊娠期高血壓性心臟病(40例,36.7%),排第三位的為圍產期心臟病(10例,9.2%),其他各種類型心臟病占15.6%。2 42例結構性心臟病(37例先天性心臟病和5例風濕性心臟病)患者中曾行心臟手術治療的有13例(30.9%),主要為房/室間隔缺損修補術和心臟瓣膜置換術,其中心功能Ⅱ級11例,心功能Ⅲ、Ⅳ級各1例。心臟手術能改善孕期患者心功能狀態(tài),與非手術組相比,差異有統(tǒng)計學意義(P0.05)。3 109例患者中活產94例,死產15例,心功能Ⅲ-Ⅳ級組的死產率高于心功能Ⅱ級組(P0.01);活產患者中,早產35例,足月產59例,心功能Ⅲ-Ⅳ級組的早產率高于心功能Ⅱ級組(P0.01);活產患者中,剖宮產80例,經陰道分娩14例,心功能Ⅲ-Ⅳ級的剖宮產率高于心功能Ⅱ級組(P0.01);心功能Ⅲ-Ⅳ級組的新生兒體重、出生5min Apgar評分低于心功能Ⅱ級組(P0.05)。4比較心功能Ⅱ、Ⅲ、Ⅳ級患者初始血漿NT-pro BNP濃度,發(fā)現(xiàn)各組間存在明顯差異(P0.001),對患者心功能分級和對應的NT-pro BNP散點圖添加回歸模型擬合線,患者血漿NT-pro BNP濃度與心功能分級呈正相關(n=96,R2=0.542,P0.05)。5妊娠期高血壓性心臟病組和結構性心臟病組各組內比較血漿NTpro BNP濃度,心功能Ⅲ-Ⅳ級組NT-pro BNP水平明顯高于心功能Ⅱ級組(P0.01);比較不同類型心臟病患者初始血漿NT-pro BNP濃度,結構性心臟病組與妊娠期高血壓性心臟病組相應亞組間比較均無顯著性差異(P0.05),圍產期心肌病組血漿NT-pro BNP水平高于妊娠期高血壓性心臟病組和結構性心肌病組(P0.05)。6繪制受試者工作特征曲線,NT-pro BNP判斷結構性心臟病患者預后的曲線下面積為0.896,95%置信區(qū)間為(0.799,0.992),最佳截斷值為1474.34pg/m L,該點對應的敏感度為88.9%,特異度為84.8%,約登指數(shù)為0.737。結論:1于我院急診科就診的妊娠合并心臟病患者主要以結構性心臟病、妊娠期高血壓性心臟病和圍產期心肌病為主,死亡患者主要以結構性心臟病患者為主,行相關心臟手術治療能改善結構性心臟病患者妊娠后的心功能狀態(tài)。2妊娠合并心臟病患者心功能狀態(tài)與圍生兒結局密切相關,心功能Ⅲ-Ⅳ級患者出現(xiàn)圍生兒不良妊娠結局的機率高于心功能Ⅱ級患者。3血漿NT-pro BNP濃度在評估妊娠合并心臟病患者心功能時有重要的臨床價值,但在應用NT-pro BNP評估患者心功能狀態(tài)及預測患者預后時應結合具體心臟病類型進行判斷。
[Abstract]:Objective: to investigate the type distribution of pregnancy complicated with heart disease in emergency department of our hospital and to explore the value of initial NT-pro BNP detection in the evaluation of cardiac function and prognosis in pregnant patients with heart disease. Methods: the clinical data of 109 pregnant patients with heart disease received by the Emergency Department of the second Hospital of Hebei Medical University from January 2013 to December 2016 were collected retrospectively. the data were collected and analyzed by SPSS21.0 statistical software. Results: 1structural heart disease was the main cause of pregnancy complicated with heart disease in emergency department of our hospital (including 37 cases of congenital heart disease and 5 cases of rheumatic heart disease, accounting for 38.5%), followed by hypertensive heart disease during pregnancy (40 cases). 36.7%), the third largest was postpartum heart disease (10 cases, 9.2%). Other types of heart disease accounted for 15.6%. Among 42 patients with structural heart disease (37 congenital heart disease and 5 rheumatic heart disease), 13 (30.9%) had undergone cardiac surgery. The main results were atrial / ventricular septum defect repair and cardiac valve replacement. There were 11 cases of central function grade 鈪，

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