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妊娠期体外循环心脏手术后妊娠结局及影响因素分析
李玉欣1，2，汪珍忠1，2，赵俊飞1，2，张朝龙1，2，柯英杰1，2，3，王秋吉1，2，钟丽珊1，2，庞善文1，2，丘俊强1，2，柳艳丽4，张　晨5，黄焕雷1，2
1.南方医科大学附属广东省人民医院（广东省医学科学院）心外科，广州 510080；2.广东省心血管病研究所，广州 510100；3.广东省人民医院南海医院（佛山市南海区第二人民医院）心外科，佛山 528000；4.南方医科大学附属广东省人民医院（广东省医学科学院）产科，广州 510080；5.复旦大学附属妇产科医院生殖与发育研究所，上海 200090
摘要:
［摘要］　目的　分析妊娠期体外循环（CPB）心脏手术后妊娠结局及影响因素。方法　回顾性分析2010年1月至2023年12月在广东省人民医院心外科行妊娠期CPB心脏手术治疗的56例患者的临床资料。根据术后1周胎儿是否存活，将患者分为胎儿存活组（45例）和胎儿死亡组（11例）。比较两组临床资料。采用多因素logistic回归分析胎儿死亡的影响因素。结果　56例患者未发生母体死亡。胎儿存活组45例中1例为双胎妊娠。胎儿死亡组11例，为单胎妊娠。胎儿死亡率为19.30%（11/57）。胎儿存活组妊娠期美托洛尔使用人数占比高于胎儿死亡组，手术时间、CPB时间短于胎儿死亡组，术中出血量低于胎儿死亡组，围手术期输血率低于胎儿死亡组，围手术期使用阿托西班人数占比高于胎儿死亡组，差异有统计学意义（P<0.05）。多因素logistic回归分析结果显示，围手术期输血是胎儿死亡的独立危险因素（P<0.05），妊娠期使用美托洛尔、围手术期使用阿托西班是抑制胎儿死亡的独立保护因素（P<0.05）。结论　妊娠期CPB心脏手术对胎儿的威胁超过母体，围手术期输血是胎儿死亡的独立危险因素，妊娠期使用美托洛尔、围手术期使用阿托西班是抑制胎儿死亡的独立保护因素。
关键词:  妊娠  体外循环  心脏手术  妊娠结局
DOI：10.3969/j.issn.1674-3806.2025.11.10
分类号:
基金项目:广州地区临床高新、重大和特色技术项目（编号：2023P-GX08，2023FTJCZ0011）
Analysis on pregnancy outcomes and influencing factors after cardiac surgery under cardiopulmonary bypass in pregnancy
LI Yuxin1,2, WANG Zhenzhong1,2, ZHAO Junfei1,2, ZHANG Chaolong1,2, KE Yingjie1,2,3, WANG Qiuji1,2, ZHONG Lishan1,2, PANG Shanwen1,2, QIU Junqiang1,2, LIU Yanli4, ZHANG Chen5, HUANG Huanlei1,2
1.Department of Cardiac Surgery, Guangdong Provincial People′s Hospital of Southern Medical University(Guangdong Academy of Medical Sciences), Guangzhou 510080, China; 2.Guangdong Cardiovascular Institute, Guangzhou 510100, China; 3.Department of Cardiac Surgery, Guangdong Provincial People′s Hospital′s Nanhai Hospital(the Second People′s Hospital of Nanhai District), Foshan 528000, China; 4.Department of Obstetrics, Guangdong Provincial People′s Hospital of Southern Medical University(Guangdong Academy of Medical Sciences), Guangzhou 510080, China; 5.Institute of Reproduction and Development, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200090, China
Abstract:
［Abstract］　Objective　To analyze the pregnancy outcomes and influencing factors after cardiac surgery under cardiopulmonary bypass in pregnancy. Methods　The clinical data of 56 patients who underwent cardiac surgery under cardiopulmonary bypass(CPB) in pregnancy in Department of Cardiac Surgery, Guangdong Provincial People′s Hospital from January 2010 to December 2023 were retrospectively analyzed. According to whether the fetuses survived 1 week after surgery, the patients were divided into fetal survival group(45 patients) and fetal death group(11 patients). The clinical data were compared between the two groups. Multivariate logistic regression was used to analyze the influencing factors of fetal death. Results　There were no maternal deaths among the 56 patients. Among the 45 patients of the fetal survival group, 1 case belonged to a twin pregnancy. There were 11 cases in the fetal death group, all of whom were singleton pregnancies. The fetal mortality rate was 19.30%(11/57). The proportion of patients receiving metoprolol treatment during pregnancy in the fetal survival group was higher than that in the fetal death group, and the duration of operation and duration of CPB in the fetal survival group were shorter than those in the fetal death group, and the intraoperative blood loss in the fetal survival group was less than that in the fetal death group, and the perioperative blood transfusion rate in the fetal survival group was lower than that in the fetal death group, and the proportion of patients receiving atosiban treatment during the perioperative period in the fetal survival group was higher than that in the fetal death group, with statistically significant differences between the two groups(P<0.05). The results of multivariate logistic regression analysis showed that perioperative blood transfusion was an independent risk factor for fetal death, while receiving metoprolol treatment during pregnancy and receiving atosiban treatment during the perioperative period were independent protective factors for inhibiting fetal death(P<0.05). Conclusion　Cardiac surgery under CPB during pregnancy poses a greater threat to the fetuses than to their mothers. Perioperative blood transfusion is an independent risk factor for fetal death. Receiving metoprolol treatment during pregnancy and receiving atosiban treatment during the perioperative period are independent protective factors for inhibiting fetal death.
Key words:  Pregnancy  Cardiopulmonary bypass(CPB)  Cardiac surgery  Pregnancy outcomes