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目的：探讨妊娠合并心脏病患者围产期心衰的处理方法和分娩方式。方法：对１９８９ ～１９９８ 年收住院的１７６ 例妊娠合并心脏病患者的临床资料进行回顾分析。结果：妊娠合并心脏病的发生率为１ ．５ ％ ，心脏疾病构成比中，以风心病居首位，先心病、心肌炎、妊高征心脏病分别居第二、三、四位。本组心功能Ⅱ～Ⅳ级者９２ 例（５２ ．３ ％ ） ，其中左心衰５６ 例，右心衰７ 例，全心衰２９ 例。心衰发生于３２ ～３６ 孕周者６５ 例（７０ ．７ ％ ） ，发生于３６ 孕周以后者２０ 例（２１ ．７ ％ ） 。产程中发生急性肺水肿者７ 例，均为风心病、 Ｍ Ｓ 合并 Ａｆ 患者。剖宫产１０８ 例（６１ ．４ ％ ） ，其中心功能Ⅰ～Ⅱ级者７７ 例，Ⅲ～Ⅳ者３１ 例。新生儿死亡３ 例，均系宫内缺氧所致。产妇死亡３ 例，其中２ 例死于产后急性肺水肿，１ 例死于产后心室颤动。结论：要加强对早期心衰的防治，把好３２ ～３６孕周、第二产程、产后“三大关口”。联合使用强心、利尿、血管扩张剂治疗可获得良好效果，在连续硬膜外麻醉下行剖宫产术终止妊娠是抢救母婴生命的有效措施。
Objective: To investigate the treatment and delivery methods of perinatal heart failure in patients with pregnancy complicated with heart disease. Methods: The clinical data of 176 pregnant women with heart disease admitted in the hospital from 1989 to 1998 were analyzed retrospectively. Results: The incidence of pregnancy complicated with heart disease was 1. 5%, constitution ratio of heart disease, the first place of rheumatic heart disease, congenital heart disease, myocarditis, pregnancy-induced hypertension heart disease ranked second, third and fourth respectively. This group of 92 patients with heart function Ⅱ ~ Ⅳ (52.3%), including 56 cases of left heart failure, right heart failure in 7 cases, 29 cases of heart failure. Heart failure occurred in 32 to 36 gestational weeks in 65 cases (70.7%), occurred in 36 weeks after the gestational age in 20 cases (21.7%). 7 cases of acute pulmonary edema occurred in the labor process, both of rheumatic heart disease, M S merged with Af patients. Cesarean section in 108 cases (61.4%), whose central function Ⅰ ~ Ⅱ in 77 cases, Ⅲ ~ Ⅳ in 31 cases. Neonatal death in 3 cases, are due to intrauterine hypoxia. 3 maternal deaths, of which 2 died of postpartum acute pulmonary edema and 1 died of postpartum ventricular fibrillation. Conclusion: To strengthen the prevention and treatment of early heart failure, take a good 32 ~ 36 gestational weeks, the second stage of labor, postpartum “three mark.” Joint use of cardiac, diuretic, vasodilator therapy can get good results in continuous epidural anesthesia cesarean termination of pregnancy is an effective measure to save maternal and child life.