妊娠合并重度肺动脉高压多学科联合诊治15例临床分析  

Multidisciplinary diagnosis and treatment of 15 cases of pregnancy complicated with severe pulmonary hypertension

作　　者：卢玉凤 孙晓彤[1] 李星辉[2] 单龙[1] 毛燕[1] 魏芬[1] 王培萍 姜倩 LU Yufeng;SUN Xiaotong;LI Xinghui;SHAN Long;MAO Yan;WEI Fen;WANG Peiping;JIANG Qian(Department of Obstetrics,Gansu Provincial People′s Hospital, Lanzhou 730000,China;Department of Cardiology,Gansu Provincial People′s Hospital;The 63600 Troop Hospital of the Chinese People′s Liberation Army)

机构地区：[1]甘肃省人民医院产科,甘肃兰州730000 [2]甘肃省人民医院心内科 [3]解放军63600部队医院

出　　处：《西北国防医学杂志》2021年第6期483-488,共6页Medical Journal of National Defending Forces in Northwest China

基　　金：国家自然科学基金资助项目(81660065)。

摘　　要：目的:探讨妊娠合并重度肺动脉高压患者的围产期临床特点、治疗方案及妊娠结局。方法:收集甘肃省人民医院产科2016-01~2020-12收治的15例妊娠合并重度肺动脉高压患者的临床病例资料,并进行回顾性分析。结果:15例患者平均年龄(26.7±4.8)岁,入院孕周(18+6~39)周;心脏病类型:动脉导管未闭4例,心脏瓣膜病4例,房间隔缺损4例,室间隔缺损3例,法洛四联症3例;心功能Ⅱ级1例、Ⅲ级6例、Ⅳ级8例。终止妊娠前后血红蛋白(hemoglobin,HGB)、脑钠肽(brain natriuretic peptide,BNP)、肌酸激酶同工酶(creatine kinase isoenzymes,CK-MB)、左心室射血分数(left ventricular ejection fractions,LVEF)和血氧饱和度(SpO2)差异均有统计学意义(P<0.05)。白细胞计数(WBC)、血小板计数(PLT)、肌酸激酶(CK)差异均无统计学意义(P>0.05)。孕妇结局:15例患者中,1例行利凡诺引产,其余14例均行剖宫产终止妊娠。10例患者在剖宫产术后住ICU治疗。新生儿结局:1例流产,其余14例新生儿均存活,其中10例因早产转NICU治疗,随访时均存活。结论:先天性心脏病和风湿性心瓣膜病可能是妊娠合并肺动脉高压最常见的病因;妊娠合并重度肺动脉高压患者经多学科联合诊治(multidisciplinary diagnosis and treatment,MDT)具有较好的临床效果,在围产期病情评估,延长孕周,及时准确的判断终止妊娠时机,保障母婴安全具有一定的优势。Objective:To investigate the perinatal clinical features,treatment plan and pregnancy outcome of patients with severe pulmonary hypertension(PAH)in pregnancy.Methods:The clinical data of 15 pregnant women with PAH who were admitted to the obstetrics department of Gansu Provincial People′s Hospital from January 2016 to December 2002 was collected,and was retrospectively analyzed and summarized.Results:The average age of 15 patients was(26.7±4.8)years old.Hospital gestational was(18+6-39)weeks,the type of heart disease:4 cases of patent ductus arteriosus,4 cases of valvular heart disease.There were 4 cases of atrial septal defect,3 cases of ventricular septal defect,3 cases of tetralogy of fallot.1 case of grade II,6 cases of grade III,and 8 cases of grade IV.The differences in hemoglobin(HGB),brain natriuretic peptide(BNP),creatine kinase isoenzyme(CK-MB),left ventricular ejection fraction(LVEF)and blood oxygen saturation(SpO2)before and after termination of pregnancy were statistically significant(P<0.05).There was no significant difference in white blood cell count(WBC),platelet count(PLT),and creatine kinase(CK)(P>0.05).Maternal outcome:1 case received rivanol to induce labor,and the other 14 cases were terminated by cesarean section.Ten patients were treated in ICU after cesarean section.Eonatal outcome:1 case of miscarriage,and the remaining 14 newborns were alive,and 10 cases were transferred to NICU due to premature delivery and all were alive during follow-up.Conclusion:Congenital heart disease and rheumatic valvular heart disease may be the most common causes of pregnancy complicated with pulmonary hypertension.Pregnancy with PAH has a good clinical effect through multidisciplinary diagnosis and treatment.Periodic disease assessment,prolonged gestational weeks,timely and accurate judgment of the timing of pregnancy termination,and protection of mother and baby safety have certain advantages.

关 键 词：妊娠合并重度肺动脉高压 多学科联合诊治 先天性心脏病 

分 类 号：R714.25[医药卫生—妇产科学]