妊娠合并房缺伴肺动脉高压患者的妊娠结局及相关因素探讨

Pregnancy outcomes and related factors of atrial septal defect complicating with pulmonary hypertension in 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和相关因素。方法对2006年1月至2014年9月收治的46例中晚期妊娠合并房缺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为轻度组13例、中度组14例和重度组19例。检查其房间隔缺损的类型、面积及心功能分级,检测孕妇入院前的氧分压、氧饱和度、血小板值、肺动脉收缩压与体循环收缩压比值（Pp/Ps）,计算婴儿的足月分娩的数量、早产的数目及医源性流产、新生儿窒息的数目以及新生儿体重指标。结果与轻、中度组比较,重度组非单一缺损、大缺损型及孕中晚期心功能分级为Ⅲ~Ⅳ级的比率显著升高（P〈0.05）;与轻、中度组比较,重度组氧分压、氧饱和度、血小板值明显降低,Pp/Ps明显升高,差异均有统计学意义（P〈0.05）。重度组早产、医源性流产、新生儿窒息、孕妇心衰发生率高于中度组及轻度组（P〈0.05）。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,孕产妇病死率、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 pregnancy outcomes and related factors of atrial septal defect（ ASD） complicating with pulmonary hypertension in pregnant women patients. Methods We retrospectively analyzed 46 pregnant women patients of ASD with pulmonary hypertension who were treated in our hospital from 2006 to 2014. The patients were divided into 3 groups according to their systolic pressure of pulmonary artery. Mild group（ n = 13）,moderate group（ n = 14）,and severe group（ n = 19）. The type and dimension of atrial septal and pregnant women＇s heart function was checked. Arterial oxygen partial pressure,oxygen saturation and platelet value and Pp / Ps of women were monitored before therapy.The amount of full- term neonates,premature,asphyxia neonatorum and iatrogenic abortion and the birth weight were analyzed. SPSS 14. 0 was used to analysis the results. Results A total of 17 patients with NYHA class Ⅲ ~ IV,and 3 of them from Mild group,2 from Moderate group and12 from Severe group,there was a significant difference between Mild group and Severe group（ P〈0. 05）. Compared with Mild and Moderate groups,Severe group had significantly decreased arterial oxygen partial pressure,oxygen saturation and platelet value（ P〈0. 05）. 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. There 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.