妊娠合并肺动脉高压患者剖宫产围产期并发症的危险因素分析  

Risk factors of perinatal complications in patients with pulmonary hypertension underwent cesarean section in 4 Chinese centers

作　　者：张君[1] 逯伟达 李敏[3] 李国[4] 冯华 张红雨[2] 纪求尚[6] 崔晓霈[2] Zhang Jun;Lu Weida;Li Min;Li Guo;Feng Hua;Zhang Hongyu;Ji Qiushang;Cui Xiaopei(Department of Cardiovascular Surgery,Qilu Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250012,China;Department of Geriatric Medicine&Shandong Key Laboratory Cardiovascular Proteomics,Qilu Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250012,China;Intensive Care Unit of Cardiac Surgery,Shandong Provincial Qianfoshan Hospital,First Hospital Affiliated to Shandong First Medical University,Affiliated Hospital of Shandong University,Jinan 250014,China;Department of Pulmonary and Critical Care Medicine,Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Gastroenterology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Department of Cardiology,Qilu Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院心脏外科,济南250012 [2]山东大学齐鲁医院保健科(老年医学科)山东省心血管疾病蛋白质组学重点实验室,济南250012 [3]山东第一医科大学第一附属医院(山东省千佛山医院)心脏外科监护室,济南250014 [4]青岛大学附属医院呼吸与危重症医学科,青岛266000 [5]山东第一医科大学附属省立医院消化内科,济南250021 [6]山东大学齐鲁医院心内科,济南250012

出　　处：《中华心血管病杂志》2022年第1期43-48,共6页Chinese Journal of Cardiology

基　　金：山东省重点研发计划(2019GSF108052);山东省自然科学基金博士基金(ZR2017BH047)。

摘　　要：目的探讨妊娠合并肺动脉高压患者剖宫产围产期并发症的危险因素。方法该研究为病例对照研究。回顾性纳入山东大学齐鲁医院、山东第一医科大学附属省立医院、山东省千佛山医院和青岛大学附属医院2010年5月至2020年5月妊娠合并肺动脉高压患者。根据是否发生剖宫产围产期并发症分为并发症组和对照组。收集患者的一般临床资料和辅助检查结果,记录患者发生围产期并发症的情况。围产期并发症包括心功能恶化、新发心律失常、心脏骤停、术后42 d内全因死亡、产后出血及血栓事件。采用多因素logistic回归模型分析妊娠合并肺动脉高压患者剖宫产围产期并发症的危险因素。结果研究纳入患者167例,年龄28(24,32)岁,其中并发症组47例,对照组120例。两组患者年龄,孕周,初产妇、存在心内分流及接受靶向药物治疗者比例,左、右心室舒张末期内径差异均无统计学意义(P均>0.05)。与对照组比较,并发症组患者特发性肺动脉高压者比例较高(P=0.001)、接受全身麻醉的比例较高(P=0.001)、超声心动图估测的肺动脉收缩压较高(P<0.001)、术前世界卫生组织(WHO)功能Ⅲ/Ⅳ级者比例较高(P<0.001)、血清N末端B型利钠肽原和总胆红素(TBIL)水平升高者比例均较高(P均<0.05),而血清白蛋白水平降低者比例较高(P=0.041)。共47例患者发生62例次围产期并发症,其中心功能恶化28例次、新发心律失常4例次、心脏骤停2例次、出血与血栓事件11例次、死亡17例。多因素logistic回归分析结果显示WHO功能Ⅲ/Ⅳ级(OR=2.416,95%CI 1.016~5.743,P=0.046)和TBIL水平升高(OR=6.874,95%CI 1.643~28.757,P=0.008)是妊娠合并肺动脉高压患者剖宫产围产期并发症的独立危险因素。结论WHO功能Ⅲ/Ⅳ级和TBIL水平升高是妊娠合并肺动脉高压患者剖宫产围产期并发症的独立危险因素,关注这两项指标有助于早期识别高危患者。Objective To identify the risk factors related to perinatal complications in patients with pulmonary hypertension underwent cesarean section.Methods We retrospectively analyzed the medical records of all pregnant women with pulmonary hypertension hospitalized in 4 different hospitals in Shandong province and underwent cesarean section between May 2010 and May 2020.Patients were divided into perinatal complication group and control group according to the presence or absence of perinatal complications.Perinatal complications included aggravated heart function,new onset arrythmias,sudden cardiac arrest,all-cause death within 42 days post cesarean section,postpartum bleeding and thrombotic events.Risk factors of perinatal complications were analyzed.Results A total of 167 patients(47 cases in the perinatal complication group and 120 cases in the control group)were included in this study.The average age of this cohort was 28(24,32)years,and 75(44.9%)patients suffered newly diagnosed pulmonary hypertension during pregnancy.The main cause of pulmonary hypertension was congenital heart disease(137(82.0%)).Age,pregnant weeks,percent of primipara,intra-cardiac shunt,and receiving targeted medication therapy,cardiac dimensions were similar between the two groups.A total of 62 complications were recorded in the complication group including 28 cases of aggravated heart function,4 cases of new onset arrythmias,2 cases of cardiac arrest,11 cases of bleeding or thrombotic events and 17 patients were dead.Prevalence of idiopathic pulmonary hypertension and general anesthesia was significantly higher,functional capacity was significantly lower in perinatal complication group than in control group(all P<0.05).The estimated systolic pulmonary artery pressure,serum N-terminal pro-B type natriuretic peptide and total bilirubin(TBIL)levels were significantly higher in perinatal complication group than in control group(all P<0.05).Logistic analysis demonstrated WHO Function Class(FC)Ⅲ/Ⅳ(OR=2.416,95%CI 1.016-5.743,P=0.046)and TBIL le

关 键 词：高血压 肺性 妊娠 剖宫产术 并发症 总胆红素 

分 类 号：R714.252[医药卫生—妇产科学] R719.8[医药卫生—临床医学]