先天性心脏病伴肺动脉高压妊娠问题的研究进展

Advances about Pulmonary Hypertension Associated with Congenital Heart Disease in Pregnancy

妊娠对先天性心脏病相关性肺动脉高压患者最重要的影响是血容量的增加、外周循环阻力下降及高凝状态。心功能、运动耐量、肺动脉压力、血氧饱和度和脑钠肽等是监测母体心血管疾病发病率的重要指标。肺动脉高压极易引发肺部微血栓形成,先天性心脏病相关性肺动脉高压患者在产后应给予抗凝治疗。维持相对较高的体循环压力,可减少右向左分流。在围术期使用扩血管药物可提高手术生存率,但在孕期如何用药仍需进一步研究,避免妊娠或适时剖宫产终止妊娠均可获得较好结局。

The most important effect on CHD-PAH patients in pregnancy is blood volume increasing,peripheral circulation resistance decreasing and hypercoagulable state.Cardiac function prediction,exercise tolerance,pulmonary artery pressure,oxygen saturation and brain natriuretic peptide are important indicators to monitor maternal cardiovascular morbidity.Pulmonary hypertension can easily lead to pulmonary micro-thrombosis,CHD-PAH patients should be given anticoagulation therapy postpartum.Vasodilator effect on pulmonary hypertension patients,may improve surgical survival.Right to left shunt can be reduced by maintaining a relatively high systemic pressure.It needs further study how to medicate during pregnancy.Avoid pregnancy or timely termination of pregnancy by cesarean plane can obtain better outcome.