妊娠合并肺动脉高压23例妊娠结局分析

Pregnancy outcome analysis of 23 pregnant women with pulmonary arterial hypertension

目的 探讨妊娠合并肺动脉高压患者的防治方法及母婴结局.方法 回顾性分析2003年6月至2013年5月间收治的23例妊娠合并肺动脉高压患者的临床资料,分析肺动脉高压及心力衰竭发生、妊娠终止方法及母婴结局情况.结果 23例患者中轻度肺动脉高压8例,中度9例,重度6例,出现心力衰竭14例,约占60.9％,中、重度肺动脉高压患者心力衰竭发生率明显高于轻度肺动脉高压患者（P＜0.05）;2例中期妊娠患者利凡诺尔羊膜腔注射引产,5例心力衰竭难以控制的中期妊娠患者剖宫取胎术,3例轻度肺动脉高压患者在严密监护下经阴道分娩,13例在连续硬膜外麻醉剖宫产分娩.围生儿医源性引产7例,早产12例,足月产4例;出现新生儿窒息7例,死亡3例.孕产妇死亡4例,另19例心功能好转出院.结论 妊娠合并肺动脉高压应早期诊断,准确风险评估,改善患者心功能,加强产前检查及监护措施,适时终止妊娠,有助于改善患者预后,获得较好妊娠结局.

Objective To investigate the prevention method and mother and fetus outcomes of pregnant women with pulmonary arterial hypertension （PAH）.Methods The clinical data of 23 pregnant women with PAH who treated in the first people＇ s hospital of Shangqiu from June 2003 to May 2013were retrospectively analyzed.System analysis was taken on their PAH,cardiac failure occmrence,pregnancy termination method and mother and fetus outcomes.Results Among the 23 cases of patients,there were 8 cases with mild PAH,9 cases with moderates PAH and 6 cases with serious PAH.Fourteen cases（60.9％） with cardiac failure,the cardiac failure occurrence rate of the patients with moderates and serious PAH was obviously higher than that of the patients with mild PAH （P ＜ 0.05）.Two cases of midtrimester pregnancy induced labor with rivanol injection in their amnion cavity,5 cases of midtrimester pregnancy with unmanageable cardiac failure induced labor with cesarean section,3 cases of patients with mild PAH were taken vaginal delivery method under the closely monitoring,13 cases were taken continuous epidural anesthesia cesarean section.Seven perinatal infants were iatrogenic induced labour,12 cases were premature delivery,4 cases were partus matures.Seven newborns occurred neonatal asphyxia and three of them died,in the total 23 cases of the pregnant and lying-in women,4 cases died,19cases left the hospital for their cardiac function improved.Conclusions Pregnant woman with PAH should take early diagnosis and exact risk assessment,improve the patients＇ cardiac function,strengthen antenatal examination and monitoring measures,terminate pregnancy in time,which can improve the patients＇ prognosis and get better pregnancy outcome.