妊娠合并肺动脉高压患者不同程度肺动脉高压与妊娠结局临床分析

Clinical analysis of the effects of abnormal pulmonary artery hypertension during pregnancy on pregnancy outcomes

目的探讨妊娠合并肺动脉高压(PAH)患者的妊娠结局。方法回顾性分析2006年1月至2020年12月河北医科大学第二医院收治的妊娠合并PAH 193例患者的临床资料。采用心脏彩色多普勒超声测定肺动脉收缩压,分为轻度组42例(肺动脉收缩压30~49 mmHg),中度组75例(肺动脉收缩压50~79 mmHg),重度组76例(肺动脉收缩压≥80 mmHg),比较各组肺动脉高压的病因、心功能及母儿结局。结果(1)193例患者中,先天性心脏115例(59.59%),肺动脉高压程度与患者心功能分级呈显著正相关(r=0.362,P<0.001);(2)重度组的早产发生率(53.16%,48/76)、低体质量儿率(37.68%,26/69)、新生儿窒息率(14.5%,10/69)、孕妇及新生儿转ICU率(77.63%,59/76;72.46%,50/69)、孕妇死亡率(8.81%,17/193),均高于轻度组(P<0.05);(3)影响孕产妇预后的相关因素分析显示,患者不规律产前检查(P=0.006)、重度肺动脉高压(P<0.001)、心功能不全(P=0.003)、全麻(P<0.001)是影响患者妊娠结局的因素。结论妊娠合并PAH严重威胁母儿生命。

Objective To analyze the effects of different degree of pulmonary arterial hypertension(PAH during pregnancy on pregnancy outcomes.Methods Clinical data of 193 women with pulmonary arterial hypertension was collected from January 2006 to December 2020 in The Second Hospital of Hebei Medical University and they were divided into three groups on the basis of pulmonary arterial pressure.42 cases of slight group(30~49 mmHg),75cases of moderate group(50~79 mmHg),and 76 cases of severe group(≥80mmHg).The cause,cardiac functional status(New York heart association,NYHA)and outcomes of maternal and infant were compared among the groups.Results(1)Among the 193 cases,115 cases were diagnosed as Congenital heart disease,accounting for 59.59%.There were positive corelations between the degree of pulmonary artery hypertension and cardiac functional status(r=0.362,P<0.001).(2)The rate of prematurity was 53.16%(48/76),low birth weight infant 37.68%(26/69),apnoea neonatorum 14.5%(10/69),The rates of pregnant women and neonates transferred to ICU were respectively 77.63%(59/76)and 72.46%(50/69),and the maternal mortality rate was 8.81%(17/193),which were significantly higher in severe group than those in gentle group(P<0.05);(3)Analysis of the the clinical factors affecting survival for PAH during pregnancy:irregular prenatal examination(P=0.006),severe pulmonary artery height(P<0.001),cardiac dysfunction(P=0.003),general anesthesia(P<0.001)significantly affected the survival of patient.Conclusion Pregnancy complicated with PAH is a serious threat to the lives of mothers and children.