留置肺动脉导管的妊娠合并肺动脉高压患者的术后治疗  

Postoperative therapy in pregnant patients with pulmonary artery hypertension monitored by pulmonary artery catheter

作　　者：王腾科 卢家凯[2] 陈晓[1] 李强[1] 叶清[1] 高洁[1] 孙建萍[1] 耿丽敏[1] 王慧[3] 李燕娜[1] 曾哲淳[4] 张京岚[1] 

机构地区：[1]首都医科大学附属北京安贞医院综合外科监护室,100029 [2]首都医科大学附属北京安贞医院麻醉中心,100029 [3]首都医科大学附属北京安贞医院妇产科,100029 [4]北京市心肺血管疾病研究所流行病研究室,100029

出　　处：《中国医药》2017年第4期593-597,共5页China Medicine

基　　金：北京市卫生和计划生育委员会科研基金（2009-2073）

摘　　要：都医科大学附属北京安贞医院综合外科监护室收治的53例妊娠终止术后留置PAC的妊娠合并中、重度肺动脉高压患者的临床资料，按转归分为生存组（46例）和死亡组（7例），比较生存组与死亡组患者临床资料的差异。 结果43例患者诊断先天性心脏病相关肺动脉高压，10例诊断特发性肺动脉高压。34例患者行剖宫产术，19例行剖宫取胎术，其中49例患者采取连续硬膜外麻醉。术后应用血管收缩药、正性肌力药及肺动脉高压特异性治疗药物，其剂量根据血流动力学参数调节。6例患者死于肺动脉高压危象，1例死于心脏骤停，死亡率13.2%（7/53）。死亡组患者特发性肺动脉高压比例较高，且世界卫生组织心功能分级较差，术后2～36 h平均肺动脉压高于生存组，其中2、8、10、12、18、20、22、24、36 h差异有统计学意义［（70±5）mmHg（1 mmHg=0.133 kPa）比（65±4）mmHg、（70±6）mmHg比（64±4）mmHg、（72±7）mmHg比（61±4）mmHg、（67±7）mmHg比（61±4）mmHg、（66±8）mmHg比（60±4）mmHg、（68±5）mmHg比（60±4）mmHg、（66±4）mmHg比（58±4）mmHg、（65±4）mmHg比（61±5）mmHg、（70±4）mmHg比（66±3）mmHg］（P〈0.05）。42例患者发生术后并发症，其中PAC相关并发症2例。无新生儿死亡。 结论中、重度肺动脉高压孕产妇妊娠终止术中至术后1周内留置PAC是安全的，且有利于持续对患者进行肺动脉压等血流动力学监测，指导药物治疗，改善患者临床结局，降低患者短期死亡率。ObjectiveTo investigate postoperative management in pregnant patients with moderate to severe pulmonary artery hypertension（PAH） who had pulmonary artery catheterization（PAC） indelling. MethodsA total of 53 pregnant women with moderate to severe PAH who had PAC indelling from January 2006 to August 2014 in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed; 46 cases were in survival group and 7 cases died （dead group）. Clinical data were compared between groups. ResultsForty-three patients were diagnosed of congenital heart disease-associated PAH and 10 patients were diagnosed of idiopathic PAH（iPAH）. Thirty-four patients had cesarean delivery and 19 patients had therapeutic abortion; 49 patients had epidural anesthesia. Vasoconstrictors, inotropic agents and therapeutic drugs for PAH were used to maintain hemodynamic stability. Six patients died of pulmonary hypertensive crisis and 1 patient died of sudden cardiac arrest; the mortality rate was 13.2%（7/53）. The dead group had high ratio of iPAH and poor cardiac function in World Health Organization functional classification; postoperative pulmonary artery pressures at 2, 8, 10, 12, 18, 20, 22, 24, 36 h after operation in dead group were significantly higher than those in survival group[（70±5）mmHg vs （65±4）mmHg, （70±6）mmHg vs （64±4）mmHg, （72±7）mmHg vs （61±4）mmHg, （67±7）mmHg vs （61±4）mmHg, （66±8）mmHg vs （60±4）mmHg, （68±5）mmHg vs （60±4）mmHg, （66±4）mmHg vs （58±4）mmHg, （65±4）mmHg vs （61±4）mmHg, （70±4）mmHg vs （66±3）mmHg]（P〈0.05）. Postoperative complications occurred in 42 patients and 2 patients had PAC-associated complications. No neonatal death occurred. ConclusionssPAC is safe for pregnant patients with moderate to severe PAH and it provides advantages for postoperative hemodynamic monitoring and drug administering.

关 键 词：高血压 肺性 肺动脉导管 妊娠 围术期 血流动力学监测 

分 类 号：R543.2[医药卫生—心血管疾病]