摘要
目的探讨妊娠中晚期及产褥期主动脉夹层的临床特点及妊娠期管理。方法收集2012年8月-2022年2月郑州大学第一附属医院产科收治的21例妊娠中晚期及产褥期主动脉夹层孕产妇的临床资料进行分析。结果(1)临床特点:21例主动脉夹层患者发病时间为孕25周-产后1月,均出现疼痛症状,其中19例为胸部疼痛或者背部疼痛,2例为剑突下疼痛;Stanford A型11例,Stanford B型10例;主动脉宽度2.8cm-6.0cm,平均(4.2±1.1)cm;D-二聚体0.55mg/L-41.24mg/L,中位数2.15 mg/L;(2)治疗:21例患者中,17例行主动脉手术,4例入院后未来得及手术突发死亡。17例行主动脉手术的时间为孕25周-产后7 d,8例患者同时行主动脉手术+剖宫产术(或剖宫取胎术),5例患者在主动脉手术后再行终止妊娠,4例患者在剖宫产终止妊娠后行主动脉手术;(3)母儿结局:21例孕产妇中,抢救成功15例(71.4%,15/21),死亡6例(28.6%,6/21),死亡病例中4例为Stanford A型夹层,2例为Stanford B型夹层。16例新生儿产时存活,其中足月儿7例,早产儿9例;14例新生儿随访发育良好,2例早产儿最终死亡。结论妊娠合并主动脉夹层起病急骤,病情凶险,死亡率高,加强对急性主动脉夹层的认识,提高初诊的准确率,并及时进行干预,是改善母儿不良结局的关键。
Objective To investigate the clinical characteristics and management of aortic dissection in the middle and third trimesters of pregnancy and the puerperium.Methods Clinical data of 21 maternal cases of mid-late pregnancy and puerperal aortic dissection admitted to the Department of Obstetrics of the First Affiliated Hospital of Zhengzhou University from August 2012 to February 2022 were collected and analyzed.Results(1)Clinical features:21 patients with aortic dissection were onset from 25 weeks gestation to 1 month after delivery,all of whom had painful symptoms,including 19 cases of chest pain or back pain,2 cases of subxiphoid pain,11 cases of Stanford type A and 10 cases of type B,aortic width of 2.8 cm-6.0 cm,mean(4.2±1.1)cm,D-dimer 0.55 mg/L-41.24 mg/L,median 2.15 mg/L.(2)Treatment:Among the 21 patients,17 had aortic surgery and 4 died suddenly before surgery after admission.17 patients underwent aortic surgery from 25 weeks gestation to 7 days after delivery,8 patients underwent aortic surgery and caesarean section(or caesarean extraction)at the same time,5 patients had termination of pregnancy after aortic surgery,and 4 patients had aortic surgery after termination of pregnancy by cesarean section.(3)Maternal and child outcomes:Among the 21 maternal cases,15(71.4%,15/21)were successfully resuscitated and survived,and 6(28.6%,6/21)died.4 of the deaths were Stanford type A and 2 were Stanford type B.16 newborns survived at the time of delivery,including 7 full-term and 9 premature babies,14 were well-developed in follow-up,2 premature infants eventually died.Conclusion Pregnancy complicated by aortic dissection has a sudden onset,dangerous condition and high mortality.Improving the awareness of acute aortic dissection,increasing the accuracy of initial diagnosis,and providing timely interventions are key to improving adverse maternal and child outcomes.
作者
李秀芳
李灵燕
赵先兰
陶雅
凡秀丽
LI Xiufang;LI Lingyan;ZHAO Xianlan;TAO Ya;FAN Xiuli(Department of Obstetrics,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,450052,China)
出处
《新疆医学》
2023年第12期1466-1471,共6页
Xinjiang Medical Journal
关键词
主动脉夹层
妊娠
临床特点
妊娠结局
Aortic dissection
Pregnancy
Clinical features
Pregnancy outcome
作者简介
李秀芳,女,硕士,主治医师,研究方向:妊娠期心血管系统疾病。
