妊娠合并肺动脉高压149例临床分析  

Clinical analysis of 149 cases of pregnant women with pulmonary arterial hypertension

作　　者：周晓瑞[1,2] 张京岚[1,2] 卢家凯[1,3] 陈峣[1,2] 李强[1,2] 叶清[1,2] 孙建萍[1,2] 高洁[1,2] 耿丽敏[1,2] 夏星[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所综合外科ICU,北京100029 [3]北京市心肺血管疾病研究所麻醉科,北京100029

出　　处：《心肺血管病杂志》2013年第5期544-548,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都医学发展科研基金重点项目(2009-2073)

摘　　要：目的:分析综合外科ICU(SICU)收治的妊娠合并肺动脉高压(pulmonary arterial hypertension,PAH)行终止妊娠手术患者的临床特征,为临床处理提供参考。方法:回顾性分析安贞医院SICU从2004年5月至2012年12月收治的妊娠合并PAH行终止妊娠手术的患者临床资料,包括孕龄、NYHA心功能分级、心脏并发症、产科并发症、肺动脉高压危象(pulmonary hypertensive crisis,PHC)发病率及治疗结局。结果:共收集资料完整的149例PAH孕产妇临床资料,将PAH分为轻度肺动脉收缩压(sPAP40～49 mmHg,1 mmHg=0.133 kPa)、中度(sPAP 50～74 mmHg)和重度(sPAP≥75 mmHg)。其中,轻度组30例、中度组33例和重度组86例。9例患者死亡,病死率6.0%,均为重度PAH患者。与轻、中度PAH组相比较,重度PAH组患者妊娠平均年龄、孕龄差异有统计学意义(P<0.05)、NYHA心功能分级重、ICU停留时间长;随着孕龄增加,重度PAH患者比例降低;重度PAH组患者围术期心脏并发症(急性心力衰竭、围术期NYHA分级,较妊娠前NYHA分级下降幅度≥2级和心源性死亡)发病率升高,差异有统计学意义(P<0.05);16例患者并发PHC,发病率为10.7%;产科并发症发生(妊娠期高血压综合征和产后出血)与PAH程度无相关性。结论:妊娠合并PAH患者终止妊娠手术围术期各种并发症发生率较高,重度PAH显著影响患者结局。提示加强重度PAH孕产妇围术期ICU处理质量,可有利于改善妊娠合并PAH患者的治疗结局。Objective： To investigate the clinical features of pregnant women with pulmonary arterial hypertension（PAH）. Methods： A retrospective analysis of cases of pregnant women with PAH admitted to the surgical intensive care unit （SICU） of Anzhen Hospital from May 2004 to December 2012 was made. Data in- clude gestational age, NYHA classification, the incidence of cardiac complications, obstetric complications and pulmonary hypertensive crisis（PHC）, the outcomes of patients. Results： Clinical data of 149 cases of pregnant women with PAH were analyzed and they were divided into three groups ： 30 cases of slight PAH group （ systolic pulmonary artery pressure from 30 to 49 mmHg, l mmHg = 0. 133 kPa）, 33 cases of moderate PAH group （sys- tolic pulmonary artery pressure from 50 to 74 mmHg） and 86 cases of severe PAH group （ systolic pulmonary ar- tery pressure equal to or higher than 75 mmHg）. 9 women died （ mortality rate 6. 0% ） and all of them in se- vere PAH group. Compared with slight and moderate PAH group, patients in severe PAH group are younger, have a shorter duration of average gestational age, longer ICU stay and cardiac function is much worse. Along with the gestational age increased, the proportion of patients in severe PAH is decreased ; The morbidity of pa-tients with perioperative cardic complications （ acute heart failure, cardiac death and perioperative NYHA. clas- sification decreased ~〉2 than NYHA classification before pregnancy）is higher（P 〈 0. 05） ; PHC occurred in 16 patients （ 10. 7% ） ; Obstetric complications （ pregnancy-induced hypertension and postpartum hemorrhage） had no significant correlation with the degree of PAH. Conclusion： The incidence of various complications in preg- nant women with PAH is higher than others. Severe PAH significantly affect the overall outcome of these pa- tients. The results suggest that a strengthen perioperative management in SICU for patients with severe PAH is obvious useful to improve the outcome in preg

关 键 词：妊娠 肺动脉高压 心脏并发症 围术期处理 

分 类 号：R543.2[医药卫生—心血管疾病]