妊娠合并心脏病伴肺动脉高压85例的围生结局

Perinatal Outcome in Pregnant Women with Pulmonary Hypertension Complicating Cardiac Disease

目的:探讨妊娠合并心脏病伴肺动脉高压患者的母婴结局。方法:回顾性分析2004年1月至2012年10月,泰山医学院附属医院和泰安市中心医院产科收治的妊娠合并心脏病伴肺动脉高压85例患者的临床资料。根据肺动脉压力情况分为轻度组50例(30～49mmHg),中重度组35例(≥50mmHg),分析两组终止妊娠孕周和方式以及母婴结局。结果:①入院时,轻度组4个级别的心功能所占的比例与中重度组比较,差异均有统计学意义(P<0.05,P<0.01);治疗后(出院时)与治疗前相比,轻度组和中重度组心功能Ⅰ级的患者明显增多(P<0.05),心功能为Ⅱ级的患者减少(P<0.05),而Ⅲ级和Ⅳ级与治疗前比较差异无统计学意义(P>0.05)。②轻度组阴道分娩率和分娩孕周均高于中重度组(P<0.05),而轻度组医源性流产、心力衰竭和孕产妇死亡率低于中重度组(P<0.05)。③轻度组新生儿平均出生体重高于中重度组(P<0.05),轻度组早产儿和新生儿窒息所占比例均低于中重度组(P<0.05)。结论:妊娠合并肺动脉高压患者压力越高,孕妇心功能衰竭、剖宫产率和早产率随之增加,围生儿低体重、胎儿丢失率和新生儿窒息率明显增加;经积极救治,患者心功能情况有所好转,主要是心功能为Ⅱ级的患者;手术终止妊娠是比较安全的分娩方式,肺动脉压力为轻度时,在条件允许的情况下可行阴道试产。

Objective ：To evaluate the perinatal outcome in pregnant women with pulmonary hypertension complicating cardiac diease. Methods： Clinical data of 85 pregnant women with pulmonary hypertension in Affiliated Hospital,Taishan Medical University and the Central Hospital of Taian City from Jan 2004 to Oct 2012 were retrospectively analyzed. They were divided into two groups ：50 cases in slight group （pulmonary hypertension 30 to 49 mmHg） ,and 35 cases in moderate/severe group（ pulmonary hypertension over 50 mmHg）. the gestational week and method of pregnancy termination and outcomes of infants between the two groups were compared. Results ：①There were significant differences in the cardiac function on admission between the slight group and the moderate/severe group（ P 〈0. 05, P 〈0.01 ） ;comparing pretherapy and post-treatment,the slight group and moderate and severe group had more grade I cardiac function patients（ P 〈 0. 05）, and less grade 1I cardiac function patients （P 〈 0. 05） ;but there were no significant statistical differences between pretherapy and post-treatment in Ⅲ and Ⅳgrade cardiac function patients（ P 〉 0. 05）. ②vaginal delivery rate was higher and average gestational-week of termination in the slight group was longer than those in the moderate/severe group（P〈0.05）. The cases of iatrogenic abortion,heart failure patient,maternal deaths and cesarean section rate in the slight group were lower than the moderate/severe group（ P 〈0. 05）.③The birth weight of newborn in the slight group was heavier than that in the moderate/severe group（ P 〈 0. 05） ;and the proportion of premature infant and neonatal asphyxia in the slight group were lower than that in the moderate/severe group（ P 〈0. 05）. Conclusions.With the severity of pulmonary hypertension complicating cardiac disease increase,the rates of heart function failure,cesarean section rate, preterm birth rate, low birth weight, fetal loss and neonatal asphyxia increase;through treatment, the patients, mainly in those with Ⅱ grade cardiac function, heart function have improved. Cesarean section is the safer way to terminate pregnancy,and under allowed conditions,vaginal delivery can be adopted to the patients with slight pulmona- ry pressure.