中孕期合并肺动脉高压诊治分析

Diagnosis and treatment of pulmonary arterial hypertension in the second trimester

目的探讨中孕期合并肺动脉高压(PAH)患者的临床特点和诊疗方案。方法回顾性分析北京协和医院2000年1月至2021年3月收治的12例中孕期合并PAH的患者病历资料,按照肺动脉收缩压高低分为轻度、中度、重度三组,结合其原发病分析其临床特点、诊断、治疗和妊娠结局。结果患者平均年龄29岁(17~41岁),经产妇3例、初产妇9例。12例患者中5例合并免疫系统疾病、2例合并先天性心脏病、2例既往心肌炎史、1例合并肾功能不全、1例合并高血压病,1例无原发疾病。3例孕前诊断PAH(2例孕前为重度PAH、1例为中度PAH),1例孕早期诊断中度PAH,其余8例于中孕期出现临床症状后诊断。12例患者中重度6例、中度5例,轻度1例。8例经剖宫产终止妊娠,3例选择药物引产,1例轻度者继续妊娠中。共3例PAH孕妇死亡(重度组2例、中度组1例)。结论中孕期合并PAH患者中死亡率高(3/12),属于极高危孕妇;肺动脉高压越重,孕妇死亡风险越高;中重度PAH合并妊娠患者建议及时终止妊娠以改善妊娠结局。

Objective:To investigate the clinical characteristics,diagnosis and treatment of pulmonary arterial hypertension(PAH)in the second trimester.Methods:The data of 12 patients with PAH treated in Peking Union Medical College Hospital from January 2000 to March 2021 were retrospectively analyzed.The patients were divided into mild,moderate and severe groups according to the systolic pressure of pulmonary artery.The clinical features,diagnosis,treatment and pregnancy outcome were analyzed in combination with their primary diseases.Results:The mean age of patients was 29 years(17-41 years).Among them,3 patients were multiparous and 9 patients primiparous.Of the 12 patients,5 patients had immune system diseases,2 congenital heart disease,2 history of myocarditis,1 renal insufficiency,1 hypertension,and 1 had no primary disease.Three patients were diagnosed with PAH before pregnancy(2 severe and 1 moderate);one patient with moderate PAH was diagnosed in the first trimester,and the remaining eight patients were diagnosed after clinical symptoms occurred in the second trimester.Of 12 patients with PAH,6 patients were severe,5 moderate,and 1 mild.Eight patients were terminated their pregnancy by cesarean section,and 3 patients chose medical induction of labor.One patient with mild PAH continued pregnancy.Three out of those patients died(two with severe PAH and one with moderate PAH).Conclusions:In this group of patients,the mortality rate of patients with PAH in the second trimester was high(3/12),belonging to extremely high-risk pregnant women;the more serious the pulmonary hypertension is,the higher the risk of maternal death is.Timely termination of pregnancy is recommended for pregnancy patients with moderate to severe PAH to improve pregnancy outcomes.