子痫前期合并主动脉夹层孕妇的临床特点及结局:9例分析  

Clinical characteristics and outcome of aortic dissection in nine pregnant women with pre-eclampsia

作　　者：高伟娜 刘柯欣 刘冲[1] 赵先兰[1] Gao Weina;Liu Kexin;Liu Chong;Zhao Xianlan(Department of Obstetrics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院产科,郑州450052

出　　处：《中华围产医学杂志》2023年第2期139-145,共7页Chinese Journal of Perinatal Medicine

基　　金：国家自然科学基金(82004140)。

摘　　要：目的总结子痫前期合并主动脉夹层(aortic dissection, AD)孕妇的临床特点、治疗及结局。方法回顾性总结郑州大学第一附属医院2013年1月至2021年4月收治的9例子痫前期合并AD患者的临床特征、治疗情况及结局。采用描述性统计分析。结果 (1)临床特点:子痫前期合并AD占同期本院总分娩量和子痫前期分娩量的比例分别为18/100 000(9/49 166)和182/100 000 (9/4 943)。9例患者的年龄为(36.6±4.2)岁, 均为中晚孕期发病, 平均发病孕周为(31.0±4.7)周。胸背痛是主要临床表现(8/9)。7例行经胸超声心动图+计算机断层扫描血管造影确诊, 1例行经胸超声心动图+磁共振血管造影确诊, 1例行经胸超声心动图+MRI+计算机断层扫描血管造影确诊。AD分型以Stanford B型为主(8/9)。孕期血压分级中, 除1例不详外, 另8例均为重度。(2)治疗:5例孕期行降压药物治疗, 但未规律用药;4例孕期未行降压治疗。除1例病情进展迅速尚未及手术即死亡外, 其余8例均在初始治疗的基础上行胸主动脉腔内修复手术(thoracic endovascular aortic repair, TEVAR)。4例先行TEVAR, 后终止妊娠;2例先行剖宫产, 并分别于产后5 d和6 d行TEVAR;2例剖宫产与TEVAR同时进行。肺部感染为主要术后并发症(6例)。(3)分娩情况:1例母胎死亡, 另外8例患者(6例剖宫产或剖宫取胎, 2例胎死宫内经阴道分娩)的平均终止妊娠孕周为(32.9±3.6)周, 均未发生产后出血。(4)母儿结局:9例患者中8例存活, 1例死亡;随访8例存活患者7个月~8年, 1例遗留一侧肢体麻木, 1例偶尔心悸, 余结局良好。活产4例, 死胎(产)5例。新生儿存活4例, 其中低出生体重儿2例, 新生儿窒息1例。随访新生儿7~83个月, 均生长发育良好。结论子痫前期孕妇应积极控制血压, 避免发生AD;一旦出现胸背痛等表现, 应提高警惕是否发生AD。诊断AD后积极治疗, 有助于提高孕产妇及胎儿生存率。Objective To investigate the clinical characteristics,management and outcome of aortic dissection(AD)in pregnant women with pre-eclampsia.Methods Clinical characteristics,management,and prognosis of nine patients with pre-eclampsia complicated by AD who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2013 to April 2021 were retrospectively summarized using descriptive statistical analysis.Results(1)Clinical features:The incidence of pre-eclampsia complicated by AD among the total deliveries and pre-eclampsia deliveries were 18/100000(9/49166)and 182/100000(9/4943),respectively.All the nine cases of pre-eclampsia complicated by AD,with an average age of(36.6±4.2)years,presented clinical symptoms in the second or the third trimester that were mainly manifested as chest and back pain(8/9)and the average gestational week at onset was(31.0±4.7)weeks.Seven cases were confirmed by transthoracic echocardiography(TTE)and computed tomography angiography(CTA),one by TTE and magnetic resonance angiography,and one by TTE+MRI+CTA.The main classification of AD was Stanford B(8/9).In the grading of blood pressure during pregnancy,except for one case without data,eight cases were severe.(2)Management:Four women did not receive any antihypertensive treatment.However,blood pressure remained uncontrolled in the other five cases despite antihypertensive managment.Except for one death before operation due to rapid deterioration,the other eight cases all received initial treatment and thoracic endovascular aortic repair(TEVAR).Four cases underwent TEVAR prior to the termination of pregnancy.Two cases were delivered by cesarean section first,and TEVAR was performed 5 and 6 days after delivery,respectively.The other two cases undenwent cesarean section and TEVAR at the same time.Lung infection(n=6)was the main postoperative complication.(3)Delivery:Among the nine patients,one patient died,and the average termination time of the eight patients(six underwent cesarean section,including two cases with fe

关 键 词：子痫前期 动脉瘤 夹层 妊娠结局 

分 类 号：R714.244[医药卫生—妇产科学] R714.252[医药卫生—临床医学]