Bahloul M, Ben Ahmed M N, Laaroussi L, Chtara K, Kallel H, Dammak H, Ksibi H, Samet M, Chelly H, Ben Hamida C, Chaari A, Amouri H, Rekik N, Bouaziz M
Service de réanimation médicale, CHU Habib Bourguiba, route El Ain Km 1, 3029 Sfax, Tunisie.
Ann Fr Anesth Reanim. 2009 Jan;28(1):44-60. doi: 10.1016/j.annfar.2008.11.001. Epub 2008 Dec 25.
Peripartum cardiomyopathy (PPCM) is a rare and life-threatening disease of unknown aetiology. The primary objective of this review was to analysed aetiopathogeneses, clinical presentation and diagnosis, as well as pharmacological, perioperative and intensive care management and prognosis of this pathology.
We undertook a systematic review of the literature using Medline, Google Scholar and PubMed searches.
Unlike other parts of the world in which cardiomyopathy are rare, dilated cardiomyopathy is a major cause of heart failure throughout Africa. Its aetiopathogenesis is still poorly understood, but recent evidence supports inflammation, viral infection and autoimmunity as the leading causative hypotheses. This diagnosis should be limited to previously healthy women who present with congestive heart failure (CHF) and decreased left ventricular systolic function in the last month of pregnancy or within 5 months after delivery. Recently, introduction of echocardiography has made diagnosis of PPCM easier and more accurate. Conventional treatment consists of diuretics, vasodilators, and sometimes digoxin and anticoagulants, usually in combination. Patients who fail to recover may require inotropic therapy. In resistant cases, newer therapeutic modalities such as immunomodulation, immunoglobulin and immunosuppression may be considered. Prognosis is highly related to reversal of ventricular dysfunction. Compared to historically higher mortality rates, recent reports describe better outcome, probably because of advances in medical care. Based on current information, future pregnancy is usually not recommended in patients who fail to recover normal heart function.
PPCM is a rare but serious form of cardiac failure affecting women in the last months of pregnancy or early puerperium. Its aetiopathogenesis is still poorly understood. Introduction of echocardiography has made diagnosis of PPCM easier and more accurate. Prognosis is highly related to reversal of ventricular dysfunction.
围产期心肌病（PPCM）是一种病因不明的罕见且危及生命的疾病。本综述的主要目的是分析这种疾病的病因、临床表现与诊断，以及药物治疗、围手术期和重症监护管理与预后。
我们使用Medline、谷歌学术和PubMed搜索对文献进行了系统综述。
与世界其他地区心肌病罕见不同，扩张型心肌病是整个非洲心力衰竭的主要原因。其病因仍知之甚少，但最近的证据支持炎症、病毒感染和自身免疫是主要的致病假说。该诊断应限于既往健康的女性，她们在妊娠最后一个月或分娩后5个月内出现充血性心力衰竭（CHF）且左心室收缩功能降低。最近，超声心动图的引入使PPCM的诊断更容易、更准确。传统治疗通常包括利尿剂、血管扩张剂，有时还包括地高辛和抗凝剂，通常联合使用。未能恢复的患者可能需要使用强心治疗。在耐药病例中，可考虑免疫调节、免疫球蛋白和免疫抑制等新的治疗方式。预后与心室功能障碍的逆转高度相关。与历史上较高的死亡率相比，最近的报告描述了更好的结果，这可能是由于医疗护理的进步。根据目前的信息，心脏功能未能恢复正常的患者通常不建议再次妊娠。
PPCM是一种罕见但严重的心力衰竭形式，影响妊娠最后几个月或产褥早期的女性。其病因仍知之甚少。超声心动图的引入使PPCM的诊断更容易、更准确。预后与心室功能障碍的逆转高度相关。
