先天性心脏病相关肺动脉高压患者剖宫产术后死亡及胎儿不良事件危险因素分析  

Analysis of risk factors of maternal death and fetal adverse events in patients with congenital heart disease associated pulmonary hypertension after cesarean section

作　　者：王丽凤 田彬 逯伟达 邓倩 李敏[5] 傅金凤 李国[6] 冯华 纪求尚[4] 崔晓霈[3,4] Wang Lifeng;Tian Bin;Lu Weida(Department of Obstetrics,Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University,Jinan 250011;Department of Neurology,Dongying People's Hospital,Dongying 257100;Department of Geriatric Medicine&Shandong Key Laboratory Cardiovascular Proteomics,Qilu Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250012)

机构地区：[1]青岛大学附属山东省妇幼保健院产科,国家卫生健康委员会生育调控技术重点实验室,济南250011 [2]山东中医药大学附属东营医院(东营市中医院)神经内科,东营257100 [3]山东大学齐鲁医院保健科(老年医学科),济南250012 [4]山东大学齐鲁医院心内科,济南250012 [5]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250000 [6]青岛大学附属医院呼吸与危重症医学科,青岛266000 [7]山东第一医科大学附属省立医院消化内科,济南250000

出　　处：《现代妇产科进展》2023年第7期516-521,528,共7页Progress in Obstetrics and Gynecology

基　　金：山东省自然科学基金(No:ZR2021MH111)。

摘　　要：目的:探究先天性心脏病相关肺动脉高压患者剖宫产术后42d内死亡及妊娠期胎儿不良事件影响因素,并构建相关风险模型。方法:纳入自2013年3月至2020年1月来自山东省多中心的先天性心脏病相关肺动脉高压患者144例。以孕妇死亡、胎儿发生妊娠不良结局为结局变量,收集患者一般资料及肺动脉收缩压、心功能、总胆红素等相关临床资料,采用二元logistics回归分析探究结局变量的独立影响因素,并制作列线图。结果:10例患者死亡,出现胎儿不良结局77例。孕妇死亡事件发生的独立促进因素为肺动脉收缩压(PASP)(OR=2.634)、总胆红素(OR=5.242)、心功能(OR=4.07),孕妇死亡风险预测模型:P孕妇=1/{1+e-[-10.796+(0.969*PASP)+(1.657*总胆红素)+(1.404*心功能]},截断值(灵敏度,特异度)为-2.24(0.8,0.866),最大约登指数0.666,对应风险预测值均约为0.16,相应风险预测总分为119分,即得分≥119分为高危患者。NT-proBNP(OR=1.403)、总胆红素(OR=15.718)是胎儿不良结局发生的独立促进因素,白蛋白(OR=0.246)是胎儿不良结局事件发生的独立阻碍因素,胎儿不良结局风险预测模型:P胎儿=1/{1+e-[(0.3391*NT-proBNP)+(2.755*总胆红素)+(-1.404*白蛋白)]},截断值(灵敏度,特异度)为0.256(0.508,0.852),最大约登指数0.357,对应风险预测值均约为0.29,相应风险预测总分为140分,即得分≥140分为高危患者。结论:多因素综合风险预测模型能够较好的识别合并先心病相关肺动脉高压产妇中的高危人群。Objective:To explore the factors affecting the maternal death of patients with pulmonary arterial hypertension associated with congenital heart disease within 42 days after cesarean section and adverse fetal events during pregnancy,and to build the relevant risk model.Methods:A total of 144 patients with pulmonary arterial hypertension associated with congenital heart disease from multiple centers in Shandong Province from March 2013 to January 2020 were included.Clinical characteristics including pulmonary arterial systolic pressure(PASP),cardiac function,total bilirubin,etc.and maternal death and adverse fetal events were collected.Results:There were 10 maternal death and 77 adverse fetal outcomes.PASP(OR=2.634),total bilirubin(OR=5.242),and cardiac function(WHO)(OR=4.07)was independent risk factors of maternal death.The risk prediction model of pregnant women's death:Ppregnant women=1/{1+e-[-10.796+(0.969*PASP)+(1.657*total bilirubin)+(1.404*cardiac function(WHO)]},the cutoff value(sensitivity,specificity)is-2.24(0.8,0.866).The maximum Yoden index of the maternal mortality risk prediction model is 0.666,and the corresponding risk prediction values is 0.16,patients with the score≥119 points are at high-risk.NT-proBNP(OR=1.403)and total bilirubin(OR=15.718)are independent promoters of adverse fetal outcomes,while albumin(OR=0.246)is an independent hindrance of adverse fetal outcomes.The risk prediction model of fetal adverse outcome:Pfetal=1/{1+e[(0.3391*NT-proBNP)+(2.755*total bilirubin)+(-1.404*albumin)]}.The cutoff value(sensitivity and specificity)of the risk prediction model for adverse fetal outcome is 0.256(0.508,0.852),the maximum Yoden index is 0.357,the corresponding risk prediction values are about 0.29,and patients with the score≥140 points are at high-risk of fetal adverse events.Conclusion:The multifactor comprehensive risk prediction model may help to better identify patients with high-risk of maternal death and fetal adverse events in pregnant women with pulmonary arterial hypertension associ

关 键 词：先心病相关肺动脉高压 妊娠 死亡 胎儿不良结局 风险预测模型 

分 类 号：R714.3[医药卫生—妇产科学]