妊娠合并肺动脉高压的母胎结局研究  

Obstetric outcome in pregnancy complained with pulmonary hypertension

作　　者：祝彩霞[1] 熊玮[2] 杨娟[1] 陈汉青[1] 牛刚[1] 王子莲[1] 

机构地区：[1]中山大学附属第一医院妇产科,广州510080 [2]中山大学附属第一医院麻醉科,广州510080

出　　处：《中华医学杂志》2017年第47期3711-3715,共5页National Medical Journal of China

摘　　要：目的探讨不同程度肺动脉高压（PAH）对妊娠结局的影响。方法在2006年1月至2016年12月在中山大学附属第一医院住院的78例妊娠合并PAH孕产妇中，回顾病例资料，按PAH的严重程度分为轻度PAH组（轻度PAH组）、中度PAH组（中度PAH组）和重度PAH组（重度PAH组），比较不同严重程度的PAH妊娠期特点和母胎结局。采用方差分析进行统计学处理。结果轻度PAH组孕妇平均年龄为（31±5）岁，中度PAH组平均年龄（31±5）岁，重度PAH组平均年龄（27±3）岁，组间差异无统计学意义（P=0．050）。3组孕妇的自然受孕率（P=0．414）、初产情况（P=0．527）和分娩孕周（P=0．165）均差异无统计学意义。轻度PAH组中心功能Ⅰ级占64．9％，中度PAH组心功能Ⅱ级占50．0％，重度PAH组心功能Ⅲ级占54．5％，组间差异有统计学意义（P〈0．001）。不同严重程度的PAH孕妇的妊娠期糖尿病（P=0．589）、子痫前期（P=0．942）、胎膜早破（P=0．276）、瘢痕子宫（P=0．493）和产后出血（P=0．424）差异元统计学意义。轻、中、重度PAH组剖宫产率分别为84．2％、90．0％和63．6％，组间差异无统计学意义（P=0．208）。轻度PAH组中82．5％的孕妇选择椎管内麻醉，中度PAH组有90．0％选择椎管内麻醉，重度PAH组中仅有27．3％选择椎管内麻醉，组间麻醉方式差异有统计学意义（P〈0．001）。轻、中、重组PAH组围产儿（P=0．393）、新生儿窒息率（P=0．581）和小于胎龄儿发生率（P=0.324）均差异无统计学意义。但3组新生儿转科率分别为15．8％、40．0％和54．5％，组间差异有统计学意义（P=0．011）。结论不同严重程度的PAH的孕产妇的妊娠结局无明显差异，但终止妊娠方式和麻醉方式选择有差异。孕期严密监测和适时终止妊娠有利于改善其妊娠结局。Objective To identify whether pregnancy outcomes vary by the severity of pulmonary hypertension. Methods A retrospective study was conducted on 78 cases of pregnancies complained with pulmonary hypertension who delivered in the First Affiliated Hospital, Sun Yat-sen University from 2006 to 2016. The selected cases were divided into three groups according to severity of pulmonary hypertension： mild pulmonary hypertension group （mild PAH group） was defined as a mean pulmonary artery pressure 30-49 mmHg, moderate pulmonary hypertension （moderate PAH group ） as mean pulmonary artery pressure 50 -69 mmHg and severe pulmonary hypertension （severe PAH group） as mean pulmonary artery pressure 70 mmHg or greater. The clinical features, risk pregnant complication, maternal and neonatal outcomes were described between these three groups. Analysis of variance, Chi-square test was used for statistical analysis. Results The average age of mild, moderate and severe PAH group were （31 ± 5） years old, （31 ±5） years old and （27 ±3） years old, respectively （P =0. 050）. The rate of natural fertilization （P=0. 414）, parity （P=0. 527） and gestational age （P =0. 165） were similar in these three groups. In 78 pregnancies with pulmonary hypertension, 64.9% of pregnancies in mild PAH group was NYHA Ⅰ , 50. 0% of moderate PAH group was NYHA Ⅱ and 54. 5% of severe PAH group was NYHA Ⅲ（P 〈0. 001 ）. There was no significant difference in the incidence of gestational diabetes mellitus （GDM, P =0. 589）, preeclampsia （P = 0. 942 ）, premature rupture of membrane （ PROM, P = 0. 276 ）, scarred uterus （ P = 0. 493） and postpartum hemorrhage （ P = 0. 424）. The cesarean section rate was 84. 2%, 90.0% and 63.6% in three groups （P =0. 208）. However, neuraxial anesthesia was performed in 82. 5% of cases in mild PAH and 90. 0% of cases in moderate PAH, while 27.3% of cases of severe PAH underwent neuraxial anesthesia （P 〈0. 001 ）. The fetal outcome was similar in there

关 键 词：肺动脉高压 妊娠 母胎结局 

分 类 号：R714.252[医药卫生—妇产科学]