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目的:探讨心脏机械瓣膜置换术后妊娠及分娩的安全性及围产期处理措施。方法:对1993年3月～2007年6月期间21例心脏机械瓣膜置换术后的妊娠及分娩处理进行回顾性分析。结果:21例心脏瓣膜置换术后患者怀孕前的心功能(按NYHA标准)维持在正常或Ⅰ、Ⅱ级状态,均安全妊娠及分娩,无死亡病例。心脏瓣膜置换术后距妊娠时间6月～8年,平均(3.39±1.84)年。全部选择剖宫产,术中出血量为(289±241)ml。新生儿体重2 200～3 800 g,平均(2 916±379)g,未见畸形或出血。新生儿Apgar评分:1.5 min评9～10分。结论:心脏瓣膜置换术后,孕前心功能维持在Ⅰ～Ⅱ级状态时妊娠及分娩是比较安全的。单一服用较小剂量的华法林(<5 mg/d)抗凝治疗对孕妇及胎儿未见有害。心脏手术后2年即可计划怀孕,在整个妊娠及围产期要高度重视孕妇心脏功能的变化,心脏外科与妇产科密切协作对提高母婴安全显的很重要。
Objective: To investigate the safety of pregnancy and childbirth after mechanical heart valve replacement and the measures of perinatal treatment. Methods: A retrospective analysis of 21 cases of pregnancy and childbirth after mechanical heart valve replacement was performed from March 1993 to June 2007. Results: The heart function (before and after NYHA) of 21 patients after heart valve replacement was maintained in normal or grade Ⅰ and Ⅱ status. All of them were safe for pregnancy and childbirth without death. Heart valve replacement surgery from the time of 6 months to 8 years, with an average (3.39 ± 1.84) years. All choose cesarean section, intraoperative blood loss was (289 ± 241) ml. Neonatal body weight 2 200 ~ 3 800 g, an average of (2 916 ± 379) g, no abnormalities or bleeding. Neonatal Apgar score: 1.5 min rated 9 to 10 points. CONCLUSION: Pregnancy and childbirth is safe when heart function is maintained at Ⅰ ~ Ⅱ level after heart valve replacement. A single dose of warfarin at a lower dose (<5 mg / d) is not harmful to pregnant women and fetuses. Pregnancy planning can be planned 2 years after heart surgery. Changes in heart function of pregnant women are highly valued throughout the pregnancy and perinatal period. Close collaboration between cardiac surgery and obstetrics and gynecology is important for improving mother-child safety.