美国妊娠住院患者中心肌病和其他心肌疾病：2004-2006 年。
Cardiomyopathy and other myocardial disorders among hospitalizations for pregnancy in the United States: 2004-2006.
机构信息
From the Division of Heart Disease and Stroke Prevention and Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
出版信息
Obstet Gynecol. 2010 Jan;115(1):93-100. doi: 10.1097/AOG.0b013e3181c4ee8c.
OBJECTIVES
To estimate the rate of pregnancy hospitalizations for women with two groups of myocardial disorders, cardiomyopathy and other myocardial disorders, and report the rate of severe obstetric complications among these hospitalizations in delivery and postpartum periods.
METHODS
We performed a cross-sectional study using 14,323,731 hospitalizations for pregnancy identified from the 2004-2006 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project. We reported rates of pregnancy hospitalizations with cardiomyopathy and other myocardial disorders per 1,000 deliveries and rates of severe complications per 1,000 hospitalizations during delivery and postpartum periods by myocardial disease status. We compared these rates by using chi2 tests with adjustment of P values for multiple comparisons using the Bonferroni method.
RESULTS
Among all pregnancy hospitalizations, the overall prevalence of hospitalizations with myocardial disorders was 1.33 per 1,000 deliveries. The rate of pregnancy hospitalizations with cardiomyopathy was 0.46 per 1,000 deliveries (0.18 for apparent peripartum cardiomyopathy and 0.28 for other cardiomyopathies). The rate of pregnancy hospitalizations with other myocardial disorders was 0.87 per 1,000 deliveries. Myocardial disorders were rare during delivery hospitalizations (0.01%) but not uncommon among postpartum hospitalizations (4.2%). Among hospitalizations with myocardial disorders, the rate of severe complications ranged from 13.2 for acute myocardial infarction to 128.6 for adult respiratory distress syndrome and from 10.7 for pulmonary edema to 193.0 for fluid and electrolyte disorders per 1,000 delivery and postpartum hospitalizations, respectively. Among hospitalizations without myocardial disorders, the rate of severe complications ranged from 0.07 to 1.9 and from 0.4 to 65.5 for cardiac arrest and for fluid and electrolyte disorders per 1,000 hospitalizations, in delivery and postpartum periods, respectively.
CONCLUSION
Although only a minority of hospitalizations for cardiomyopathy are consistent with peripartum cardiomyopathy, cardiomyopathy and other myocardial disorders are important contributors to severe obstetric complications.
LEVEL OF EVIDENCE
III.
目的
估计两组心肌疾病（扩张型心肌病和其他心肌疾病）患者妊娠住院率，并报告这些妊娠住院分娩和产后期间严重产科并发症的发生率。
方法
我们使用医疗保健成本和利用项目 2004-2006 年全国住院患者样本进行了一项横断面研究，共纳入 14323731 例妊娠住院患者。我们报告了每 1000 例分娩中扩张型心肌病和其他心肌疾病患者的妊娠住院率，以及分娩和产后期间每 1000 例住院患者中严重并发症的发生率，并根据心肌疾病状态进行比较。我们使用卡方检验比较这些发生率，并使用 Bonferroni 法对多重比较进行 P 值调整。
结果
在所有妊娠住院患者中，心肌疾病患者的总体住院率为每 1000 例分娩 1.33 例。扩张型心肌病患者的妊娠住院率为每 1000 例分娩 0.46 例（明显围产期心肌病 0.18 例，其他心肌病 0.28 例）。其他心肌疾病患者的妊娠住院率为每 1000 例分娩 0.87 例。心肌疾病在分娩住院患者中较为罕见（0.01%），但在产后住院患者中并不少见（4.2%）。在患有心肌疾病的住院患者中，严重并发症的发生率范围为急性心肌梗死 13.2 例，成人呼吸窘迫综合征 128.6 例，肺水肿 10.7 例，产后电解质紊乱 193.0 例，每 1000 例分娩和产后住院患者分别为 1000 例。在没有心肌疾病的住院患者中，分娩和产后期间心脏骤停和电解质紊乱的严重并发症发生率分别为每 1000 例住院患者 0.07 至 1.9 例和 0.4 至 65.5 例。
结论
尽管只有少数扩张型心肌病患者符合围产期心肌病，但扩张型心肌病和其他心肌疾病是严重产科并发症的重要原因。
证据水平
III。
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