妊娠合并肺动脉高压患者围术期发生肺动脉高压危象的危险因素及麻醉管理分析  

An analysis of risk factors and anesthesia management of pulmonary hypertension crisis in pregnant patients with pulmonary arterial hypertension

作　　者：胡雅姣 李淑英 韩坤 Hu Yajiao;Li Shuying;Han Kun(Depurtment of Anesthesiology,West Chuina Second Uninersity Hospital,Sichun Uninersity,Key Iaboratory of Birth Defects and Related.Diseases of Women and Children,Minstry of Education,Chengdu Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西第二医院麻醉科,出生缺陷与相关妇儿疾病教育部重点实验室,四川成都610041

出　　处：《中国计划生育和妇产科》2022年第5期63-67,81,共6页Chinese Journal of Family Planning & Gynecotokology

基　　金：四川大学新芽基金(项目编号:kx210)。

摘　　要：目的分析妊娠合并肺动脉高压(pulmonary arterial hypertension,PAH)患者围术期发生肺动脉高压危象(pulmonary hypertension crisis,PHC)的危险因素,探讨其合理的麻醉管理方案。方法回顾性分析四川大学华西第二医院2015年1月至2020年12月行剖宫产术的妊娠合并PAH患者的临床资料,根据围术期是否发生PHC分为PHC组和非PHC组。分析两组患者的一般资料和围术期临床资料,并对围术期发生PHC的可能危险因素进行组间比较和多因素Logistic回归分析。结果共纳入81例患者,PHC组11例,非PHC组70例。与非PHC组相比,PHC组患者的术前SpO_(2)更低心功能分级更高、怀孕次数更多肺动脉压分级为重度者比例更多,差异有统计学意义(P<0.05)。患者术前SpO_(2)低(P=0.032,OR=1.223,95%CI=1.018-1.470)、心功能分级高(P=0.009,OR=0.049,95%CI=0.005-0.466)是患者发生PHC的独立危险因素。围术期发生PHC的时间点主要集中在麻醉起效后、取胎后、全麻拔管后及术后48h内。发生PHC的主要表现为SpO_(2)下降、血压降低、严重者发展为右心衰甚至死亡。主要治疗措施包括呼吸支持、提高血压、降低肺动脉压治疗等。结论在妊娠合并PAH患者的围术期管理中,可通过早期识别高危人群避免发生PHC,发生PHC后进行合理有效的抢救至关重要。Objective To analyze the risk factors of perioperative pulmonary hypertension crisis(PHC) in pregnant patients with pulmonary arterial hypertension(PAH),and explore the reasonable anesthesia management.Methods Pregnancy patients with PAH who underwent cesarean section from January 2015 to December 2020 in West China Second Hospital of Sichuan University were retrospectively analyzed, and they were divided into PHC group and non-PHC group according to whether PHC occurred during the perioperative period.The general data and perioperative clinical data of the two groups of patients were analyzed, and the possible risk factors for PHC during the perioperative period were compared between the two groups and multivariate Logistic regression analysis.Results 81 patients were enrolled in our study, with 11 patients in the PHC group and 70 patients in the non-PHC group.Compared with the non-PHC group, the patients in the PHC group had lower preoperative SpO_(2),higher cardiac function classification, more pregnancy times, and more severe pulmonary arterial pressure classification, and the difference was statistically significant(P<0.05).Multiple factors Logistic regression analysis showed that low preoperative SpO_(2)(P=0.032,OR=1.223,95% CI=1.018-1.470)and high cardiac function classification(P=0.009,OR=0.049,95% CI=0.005-0.466)were independent risk factors for PHC.PHC was more likely to happen after anesthesia, fetal childbirth, extubation and within 48 hours after operation.The main manifestations of PHC were SpO_(2) decline, blood pressure decrease, acute right heart failure and even death.The main treatment measures include respiratory support therapy, maintaining blood pressure and reducing pulmonary artery pressure.Conclusion In the perioperative management of pregnant patients with PAH,early identification of high-risk groups can be used to avoid the occurrence of PHC,and reasonable and effective rescue after the occurrence of PHC is crucial.

关 键 词：妊娠 肺动脉高压 肺动脉高压危象 麻醉 

分 类 号：R714.25[医药卫生—妇产科学] R614[医药卫生—临床医学]