妊娠合并心脏病伴肺动脉高压的临床分析

Clinical analysis of pregnancy complicated with heart disease and pulmonary hypertension

目的 探讨妊娠合并心脏病伴肺动脉高压患者的妊娠结局及治疗.方法收集2009年 9月至2012年7月北京安贞医院妇产科收治的38例妊娠合并心脏病伴肺动脉高压患者的临床资料,根据肺动脉压力分为轻度组（13例）、中度组（10例）和重度组（15例）,分析各组心脏病种类、心功能情况、妊娠周数、终止妊娠方式及母婴结局.结果 ①妊娠合并心脏病伴肺动脉高压患者中,先天性心脏病患者占94.7%（36/38）,风湿性心脏病仅占5.3%（2/38）.②轻、中度组心功能Ⅰ～Ⅱ级者为主（分别为13、8例）;重度组心功能以Ⅲ～Ⅳ级为主（共11例）,有2例患者死亡.轻度组与重度组比较差异有统计学意义（P〈0.05）.③低氧血症患者轻度组1例,中度组0例,重度组6例,3组间比较差异无统计学意义（P〉0.05）.④分娩方式以剖宫产为主,占89.5%（34/38）,麻醉方式以连续硬膜外或腰麻为主,占94.1%（32/34）.⑤足月分娩：轻度组明显多于重度组（分别为11、6例）,差异有统计学意义（P〈0.05）.⑥新生儿体重：轻度组明显高于重度组[分别为（3 141±98）、（2 374±92）g],差异有统计学意义（P〈0.05）.⑦低出生体重儿：重度组明显多于轻度组（分别为8、1例）,差异有统计学意义（P〈0.05）.结论 妊娠合并心脏病伴肺动脉高压患者的肺动脉压越高,母婴妊娠结局越差;剖宫产是比较安全的分娩方式.

Objective To discuss the treatment of pregnancy with heart disease and pulmonary hypertension. Methods Totally 38 cases of pregnancy with heart disease and pulmonary hypertension were collected from September 2009 to July 2012. According to pulmonary arterial pressure, the patients were divided into 3 groups,including 13 mild cases, 10 morderate cases and 15 severe cases. The type of heart disease, cardiac function, gestational weeks,ways to terminate pregnancy and outcomes of infant and mother were analyzed. Results ①Of all the cases, the proportion of congenital disease was 94.7（36/38）; rheumatic heart disease was 5.3%（2/38）. ②In mild and moderate groups, most were cardiac function grade Ⅰ toⅡ（13 cases and 8 cases）. In severe group, most were cardiac function grade Ⅲ toⅣ（11 cases） and two patients die. There was statistical significance between mild group and severe group. ③There was one hyoxemia patient in mild group, zero hyoxemia patient in morderate group and six hyoxemia patients in severe group. There was no statistical significance among three groups. ④The majority end pregnancy in cesarean section way[89.5%（34/38）].The major anesthesia way was lumbar anesthesia and continual epidural anesthesia[94.1%（32/34）]. ⑤Term birth in mild group were obviously more than that in severe group（11 cases vs 6 cases）. ⑥Neonatal weight of mild group was more than that of severe group[（3 141±98）g vs （2 374±92）g]. ⑦Low birth weight infants in severe group were more than those mild group（8 cases vs 1 case）. Conclusions The higher pulmonary arterial pressure brings the worse outcome of infant and mother. Cesarean section is a safe way to end pregnancy for pregnancy with heart disease with pulmonary hypertension.