妊娠合并肺动脉高压53例分析

Pulmonary Hypertension in Pregnancy:Analysis of 53 Case

目的分析妊娠合并肺动脉高压母婴情况及防治措施。方法收集我院53例妊娠合并肺动脉高压临床资料,根据心脏彩色多普勒超声间接估测肺动脉收缩压,将患者分为轻度、中度和重度三组。分析心脏情况及母婴结局。结果(1)53例患者中,风湿性心脏病和先天性心脏病分别占22.64%和45.38%;围生期心脏病8例;未发现心脏器质性改变5例。(2)53例患者49例(92.5%)行剖宫产术。2例轻度肺动脉高压孕妇经阴道分娩。中期引产2例,18例医源性早产。早产和小于孕龄儿在中度组和重度组与轻度肺动脉高压组相比,P(0.05。而出生儿窒息和病死率三组比较差异无统计学意义。(3)19例重度肺动脉高压孕妇中3例分别死于心衰、肺栓塞;6例产后病情加重经SICU和心内科治疗后出院;16例出现心衰。结论重度、中度肺动脉高压患者妊娠可危及母婴健康和生命,不宜妊娠。轻度和强烈要求妊娠的中度肺动脉高压患者应加强孕期监护和管理。围生期常规应用抗凝药和新型肺血管扩张药可改善母婴预后。

Objective To analyze the pregnancy outcomes and measures to prevention and cure for pregnancy women with pulmonary hypertension. Methods Clinical data of 40 women with pulmonary hypertension were analyzed and they were divided into three groups on the basis of Doppler transthoracic echocardiography detections. Results （ 1 ） The proportions of rheumatic heart disease and congenital heart disease were 22.64% and 45.38% ; 8 cases appeared with the perinatal heart disease and 5 cases＇ hearts structure were normal. （2） 49 cases applied cesarean section and 2 delivery naturally. 2 women were induction of labour in second trimester. In midrange and severity groups, prematurity and small gestational age were significently higher than those of gentle group . （3） 3 women died of congestive heart failure and pulmonary embolism. 6 women were treated by SICU and physician because of serious illness. Conclusion Women with midrange and severely pulmonary hypertension should avoid pregnancy. Pregnant women with pulmonary hypertension needed monitor closely and being treated with pulmonary vasodilator added decoagulant would improve outcomes of mather and infant.