妊娠合并心脏病相关肺动脉高压诊疗进展

Advances on diagnosis and treatment in pregnancy combined with cardiac disease and pulmonary hypertension

肺动脉高压的突出特征是肺血管收缩和重塑,妊娠和性激素变化加重了心脏病相关肺动脉高压病情,死亡风险高。其临床诊疗过程较为复杂,需要结合患者临床表现、心功能、体格检查、肺动脉压力及生化检查等进行综合诊断。心脏病相关肺动脉高压患者妊娠风险高,目前已经取得了一系列诊疗进展,支持治疗包括氧疗和休息、容量管理和纠正贫血等,靶向药物通过扩张肺血管、降低肺血管阻力改善该类患者的预后,心衰和严重肺动脉高压者必要时进行非药物治疗,产后应延续靶向治疗和随访评估。

Pulmonary hypertension is characterized by pulmonary vasoconstriction and remodeling,aggravated by pregnancy and sex hormone changes,and a high risk of death associated with cardiac disease.The clinical diagnosis and treatment process is complicated and requires a comprehensive diagnosis based on clinical manifestations,cardiac function,physical examination,pulmonary artery pressure,and biochemical examination.Pregnancy increased the risk of heart disease combined with pulmonary hypertension,and currently there are a series of progress in the diagnoses and treatment,such as support treatment including oxygen therapy and rest,capacity management,correction of anemia,and targeted drugs through dilating pulmonary vassels and inhibiting the pulmonary vascular resistance,to improve the prognosis of these patients.Non-drug therapy may be adopted for the patients with heart failure and severe pulmonary hypertension when necessary.Targeted therapy and follow-up evaluation should be continued to postpartum period.