不同病因妊娠合并重度肺动脉高压临床分析  

Clinical Analysis of Pregnancy Complicated with Severe Pulmonary Hypertension

作　　者：高元妹[1] 廖广园[1] 伍丽婵[1] 王银玲 王懿春 陈敦金[2] GAO Yuanmei;LIAO Guangyuan;WU Lichan(Department of Critical Care Medicine,The Third Affiliated Hospital of Guangzhou Medical University,Guangzhou Guangdong 510105,China)

机构地区：[1]广州医科大学附属第三医院重症医学科,广东广州510150 [2]广州医科大学附属第三医院产科,广东广州510150

出　　处：《实用妇产科杂志》2021年第8期599-603,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨不同病因妊娠合并重度肺动脉高压(PAH)围产期的监护及妊娠终止时机和方式。方法:收集2014年1月至2019年12月于广州医科大学第三附属医院ICU收治的妊娠合并重度PAH患者28例的临床资料,分析其病因、临床特点及妊娠结局。结果:①28例妊娠合并重度PAH患者中,病因为先天性心脏病占最大比率10例(35.7%),其次是风湿性心瓣膜病7例(25.0%),特发性肺动脉高压(IPAH)居第3位6例(21.4%),肺栓塞2例(7.1%),子痫前期2例(7.1%),系统性红斑狼疮相关性PAH 1例(3.6%)。②先天性心脏病、风湿性心瓣膜病、子痫前期、系统性红斑狼疮相关性PAH的孕妇预后良好,无一例死亡;6例IPAH患者中3例好转,3例死亡,病死率高达50.0%,均为病情极其危重由外院急诊转入本院,未进行规律的产前检查,并在产后并发了大出血;2例肺栓塞患者,1例预后良好,1例死亡,为在外院顺产后因重度心力衰竭转入本院,呼吸循环衰竭死亡。③共计26例围产儿(均为早产儿),其中存活围产儿22例,死胎4例;医源性流产儿2例。先天性心脏病孕妇的存活围产儿占87.5%(7/8),IPAH孕妇的存活围产儿占83.3%(5/6),而新生儿窒息发生率高达80.0%(4/5),且新生儿出生平均体质量较低为1656±552 g。结论:不同病因妊娠合并重度PAH的母婴结局不同,未规律行产前检查的IPAH患者预后较差,病死率最高,母婴结局最差,而先天性心脏病孕妇及围产儿的预后相对较好。规范化、全程、多学科的孕产妇管理是降低重度PAH孕产妇病死率的有效方法,是改善母婴结局的关键。Objective:To explore the perinatal monitoring and the timing of pregnancy termination in pregnancies complicated with severe pulmonary arterial hypertension(PAH).Methods:The clinical data of 28 pregnant patients with severe PAH admitted to the ICU of the Third Affiliated Hospital of Guangzhou Medical University from January 2014 to December 2019 were collected,and the etiology,clinical characteristics and pregnancy outcome were analyzed.Results:①Concerning the etiology,among 28 pregnant patients with severe PAH,congenital heart disease accounted for the largest proportion(35.7%,10 cases),followed by rheumatic valvular heart disease(25.0%,7 cases),and idiopathic pulmonary hypertension(IPAH)(21.4%,6 cases),pulmonary embolism(7.1%,2 cases),preeclampsia(7.1%,2 cases),systemic lupus erythematosus associated PAH(3.6%,1 case).②The prognosis of pregnant women with congenital heart disease,rheumatic valvular heart disease,preeclampsia,and systemic lupus erythematosus associated PAH was good,and there was no death.Among the 6 IPAH patients,only 3 cases improved,and the other 3 cases died,with a case fatality rate as high as 50.0%.All of the deaths were transferred from the emergency department of other hospitals to our hospital for extremely critical conditions,without regular prenatal examination,and all of them were complicated with massive bleeding after postpartum.Of the 2 patients with pulmonary embolism,one had a good prognosis and the other one died.The death case was transferred to our hospital due to severe heart failure after vaginal delivery in another hospital.The patient died due to respiratory and circulatory failure.③A total of 26 perinatal infants were born prematurely,among which 22 perinatal infants survived and 4 were stillborn.Two cases were iatrogenic abortion.The perinatal survival rate of the pregnant women with congenital heart disease was 87.5%(7/8),and 83.3%(5/6)of the pregnant women with IPAH,but the incidence of asphyxia was as high as 80.0%(4/5),and the mean birth weight of the newborn wa

关 键 词：妊娠 重度肺动脉高压 妊娠结局 

分 类 号：R714.252[医药卫生—妇产科学]