49例妊娠合并肺动脉高压的诊疗及预后分析  

Analysis of clinical diagnosis and treatment,and the prognosis of 49 pregnant women with pulmonary artery hypertension

作　　者：张莹[1] 石鑫玮[1] 曾万江 乔福元[1] 吴媛媛 ZHANG Ying;SHI Xinwei;ZENG Wanjiang;QIAO Fuyuan;WU Yuanyuan(Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology,Wuhan, Hubei Province, 430030)

机构地区：[1]华中科技大学同济医学院附属同济医院,武汉430030

出　　处：《中国计划生育学杂志》2020年第12期2116-2119,共4页Chinese Journal of Family Planning

摘　　要：目的:探讨妊娠合并肺动脉高压(PAH)患者妊娠结局。方法:汇总2012年10月—2018年12月在本院确诊为妊娠合并PAH的49例临床资料,对相关项目进行统计分析。结果:49例孕妇中,原发PAH 10例,心功能Ⅲ-Ⅳ级4例,死亡1例;继发PAH 39例,心功能Ⅲ-Ⅳ级10例,死亡6例。死亡7例均为重度PAH,心功能Ⅲ-Ⅳ级,手术终止妊娠,术后3d内死亡。早中孕期终止妊娠11例,晚孕期分娩者38例,共获新生儿39例,足月分娩18例,早产21例,其中新生儿窒息7例,小于胎龄儿4例,原发及继发PAH孕妇早产及新生儿并发症发生率无差异(P>0.05)。结论:原发或继发PAH孕妇母儿不良结局发生率均较高。心功能Ⅲ-Ⅳ级及重度PAH患者应尽量避免妊娠。对心功能Ⅰ-Ⅱ级、轻度PAH孕妇应予综合评估,决定终止妊娠方式及时机,以改善母儿结局。Objective:To investigate the pregnancy outcomes pregnant women with pulmonary artery hypertension(PAH).Methods:The clinical data of 49 pregnant women with PAH from October 2012 to December 2018 in Tongji Hospital were collected,and the related items were statistical analyzed.Results:Among these 49 pregnant women with PAH,10 cases were diagnosed with primary PAH,and among these 10 cases with primary PAH,there were 4 women with cardiac functionⅢ-Ⅳand 1 woman had died.39 cases in the 49 pregnant women with PAH were diagnosed by secondary PAH,and among them,there were 10 women with cardiac functionⅢ-Ⅳ,and 6 women had died.These 7 women all had died within 3 days after termination of pregnancy by surgical due to poor cardiac function(Ⅲ-Ⅳgrade)and severe PAH.Among these 49 pregnant women with PAH,there were 11 cases with termination of pregnancy during the first or the second trimester of pregnancy,and there were 38 women with delivery during the third trimester of pregnancy and there were 39 neonates.In these 39 neonates,there were 18 cases with full-term and 21 cases with premature delivery,there were 7 neonates diagnosed by neonatal asphyxia and 4 neonates diagnosed by small for gestational age(SGA).There were no statistical significant different in the complication incidences of premature and full time neonates between the women with primary PAH and the women with secondary PAH(P>0.05).Conclusion:The adverse outcomes incidences of maternal and infant of women with primary or secondary PAH were high,so the women with severe PAH and cardiac functional classⅢ-Ⅳshould avoid pregnancy.As for women with mild PAH and cardiac functional classⅠ-Ⅱ,the mode and timing of termination of pregnancy should be selected for improving the outcomes of maternal and infant.

关 键 词：妊娠合并肺动脉高压 母儿预后 不良结局 

分 类 号：R714.252[医药卫生—妇产科学]