妊娠合并房间隔缺损伴肺动脉高压36例临床分析

Clinical Analysis of Atrial Septal Defect Complicating With Pulmonary Hypertension in 36 Pregnant Women Patients

目的:探讨妊娠合并房间隔缺损(房缺)伴肺动脉高压患者的妊娠结局。方法:对2007-01至2011-09北京安贞医院产科收治的36例妊娠合并房间隔缺损伴肺动脉高压患者的临床资料进行回顾性分析,按肺动脉高压程度分轻度组11例,中度组11例,重度组14例。结果:①伴有心功能Ⅲ～Ⅳ级者13例,其中轻度组1例,中度组3例,重度组9例,重度组与轻度组比较差异有统计学意义(P<0.05)。②重度组氧分压、氧饱和度、血小板值与轻、中度组比较差异均有统计学意义(P<0.05)。③重度组新生儿出生体重与轻、中度组比较差异均有统计学意义(P<0.05)。重度组早产、流产发病率高。④孕产妇死亡3例,死亡率8.33%,均发生在重度组。结论:房间隔缺损合并肺动脉高压威胁着母婴安全。肺动脉压力越高,孕妇并发心功能不全、低氧血症、血小板减少的可能性越大,孕产妇死亡率、早产率、流产率及低出生体重儿分娩率越高,但是对于妊娠合并房间隔缺损伴有轻、中度肺动脉高压患者经过积极处理仍有望获得满意的产科结局。

Objective： To explore the clinical outcomes of atrial septal defect （ASD） complicating with pulmonary hypertension in pregnant women patients. Methods： We retrospectively analyzed 36 pregnant women patients of ASD with pulmonary hypertension who were treated in our hospital from 2007 to 2011. The patients were divided into 3 groups according to their systolic pressure of pulmonary artery. Mild group, n=11, Moderate group, n=11, and Severe group, n=14. Results： ①A total of 13 patients with NYHA class Ⅲ-Ⅳ , and 1 of them from Mild group, 3 from Moderate group and 9 from Severe group, there was a significant difference between Mild group and Severe group, P〈0.05. ② Compared with Mild and Moderate groups, Severe group had significantly decreased arterial oxygen partial pressure, oxygen saturation and platelet value, P〈0.05. ③ Compared with Mild and Moderate groups, the newborns birth weight in Severe group was significantly lower, P〈0.05. The premature birth rate and abortion rate were higher in Severe group. ④There were 3/36 （8.33%） patients died in Severe group. Conclusion： Pulmonary hypertension complicating with ASD in pregnant women is dangerous for both mother and infant. The severer pulmonary hypertension may cause the higher risk for all complications accordingly. The active treatment in ASD pregnant women with mild and moderate pulmonary hypertension could obtain satisfactory clinical outcome.