风湿性心脏病并肺高压妊娠患者的临床特征及妊娠结局

Clinical characteristics and pregnancy outcomes of pregnant patients with rheumatic heart disease and pulmonary hypertension

目的:探讨临床风湿性心脏病合并肺动脉高压的妊娠病例临床特征及治疗后的妊娠结局。方法:选取我院2013年5月与2015年5月收治风湿性心脏病与肺动脉高压合并发生的妊娠患者40例,回顾性分析其临床资料。结果:轻度肺高压17例,中度10例,重度13例。随肺动脉压力呈升高显示时,对心功能评估,表现为恶化,提示心功能评定结果与肺动脉压力检查结果呈正相关。本组应用二尖瓣球囊扩张术(PBMV)7例,瓣膜置换术10例,非手术23例。瓣膜置换与非手术比较,肺动脉压力明显降低(P<0.05)。PBMV相较非手术组,肺动脉压力在PBMV术后明显降低(P<0.05)。均采用剖宫产,足月分娩率、早产率对比,各组差异有统计学意义(P<0.05),随着肺动脉高压不断增加,临床早产率或(和)流产率也呈增加趋势。重度肺高压产妇中,本组死亡1例。结论:妊娠风湿性心脏病合并肺动脉高压时,在治疗上相对棘手,需在妊娠前对心功能积极改善,依据需要应用手术方案;而已患病例,需综合分析心功能状态、瓣膜性质,制定治疗方案,以获得理想的妊娠结局。

Objective：To investigate the clinical characteristics and pregnancy outcomes of pregnant patients with rheumatic heart disease and pulmonary hypertension. Methods： The clinical data of 40 pregnant patients with rheumatic heart disease and pulmonary hypertension, who were hospitalized in our hospital between May 2013 and May 2015, were retrospectively analyzed in the study. Results： There were 17, 10 and 13 cases of mild, moderate and severe pulmonary hypertension, respectively. The cardiac function aggravated along with the increasing pulmonary artery pressure, suggesting that the findings of cardiac function assessment and pulmonary artery pressure test results were positively correlated. There were 7 cases of percutaneous balloon mitral valvuloplasty （PBMV） , 10 of valve replacement, and 23 of non-surgery. The pulmonary artery pressure in the valve replacement group was significantly decreased compared with that in the non-surgery group （P〈0.05）. The pulmonary artery pressure in the PBMV group was significantly decreased after the operation compared with that in the non-surgery group （P〈0.05）. All patients underwent cesarean section, and there were differences in the term delivery rate and premature delivery rate between different groups （P〈0.05）. With the increasing pulmonary hypertension, the clinical premature delivery rate or （and） abortion rate also showed an increase. In the pregnant patients with severe pulmonary hypertension, 1 patient died. Conclusion： The treatment of rheumatic heart disease and pulmonary hypertension in pregnant patients is relatively complicated. The cardiac function should be improved aggressively before pregnancy, and the surgical protocol should be used according to the need. The cardiac function and valve characteristics should be analyzed comprehensively in sick patients to develop the treatment, and to obtain an ideal pregnancy outcome.