妊娠合并肺动脉高压伴心力衰竭患者的围生结局

Perinatal outcomes in pregnant women with pulmonary hypertension and concurrent congestive heart failure

目的探讨妊娠合并肺动脉高压伴心衰患者的围生结局。方法收集2000年1月至2010年12月温州医学院附属第二医院产科、心内科收治的妊娠合并肺动脉高压患者54例，其中伴心衰患者34例，分析其终止妊娠的时机、方式及围生结局，并比较肺动脉高压伴心衰患者和无心衰患者的妊娠结局。结果（1）54例妊娠合并肺动脉高压患者中，心衰发生率为62．96％（34／54），轻度、中度和重度肺动脉高压心衰发生率分别为27．78％（5／18），73．33％（11／15），85．71％（18／21），三组比较差异具有统计学意义（P〈0．05）；（2）妊娠合并肺动脉高压伴心衰患者中并发症发生率为47．06％（16／34），孕产妇病死率为17．64％（6／34），医源性胎儿丢失率为29．41％（10／34），早产发生率52．94％（18／34），新生儿窒息35．29％（12／34），围生儿死亡23．53％（8／34）。（3）妊娠合并肺动脉高压伴心衰患者以剖宫产分娩为主91．18％（31／34）。（4）妊娠合并肺动脉高压伴心衰患者医源性引产、早产，孕产妇并发症，孕产妇死亡，新生儿窒息和胎儿、新生儿死亡发生率明显高于无心衰组，差异有统计学意义（P〈0．05）。结论随着肺动脉压力的升高，孕妇心衰发生率随之增加；心衰是影响妊娠合并肺动脉高压患者围生预后的最主要因素；剖宫产终止妊娠是比较安全的分娩方式。

Objective To discuss the effect of the occurrence of congestive heart failure on the outcome of pregnant women with pulmonary hypertension. Methods Fifty-four pregnant patients complicated with pulmonary hypertension were admitted from January 2000 through December 2010. Among them, 34 had eomorbidity of congestive heart failure. The timing and mode of pregnancy termination, and perinatal outcomes were studied, and comparison was made between those with and without heart failure. Results① Of all 54 pregnant women with pulmonary hypertension, 34 had congestive heart failure. The incidences of congestive heart failure in patients with mild, moderate and severe degree of pulmonary hypertension were 27.78% （5/18）, 73.33% （11/15） and 85.71% （18/21）, respectively （P〈0.05）. ②The rate of maternal complications was 47.06% （16/34） and maternal mortality was 17.65% （6/34） in the patients with combined pulmonary hypertension and heart failure. The rate of iatrogenic fetal loss was 29.41% （ 10/34）, pre- term labor 52.94% （ 18/34）, neonatal asphyxia 35.29% （12/34） and neonatal mortality 23.53% （8/34） in case of patients with pulmonary hypertension complicated with congestive heart failure. ③The rate of Cesarean section was 91.18% （31/34） in the patients with combined pulmonary hypertension and heart failure. ④ The rates of iatrogenic induction, premature delivery, maternal complications and mortality, neonatal asphyxia and fetal or neonatal fatality were significantly higher in women with combined puhnonary hypertension and heart failure than those with simple pulmonary hypertension （ P 〈 0. 05 ）. Conclusions The risk ofheart failure increases with the severity of pulmonary hypertension. The occurrence of heart failure is the most important factor affecting the outcome of patients in pregnancy already complicated with pulmonary hypertension, and Cesarean section is the safer mode of termination of pregnancy in this cohort of women.