摘要
目的分析妊娠合并肺动脉高压(PH)患者的临床特点,探讨其妊娠分娩时机和方式。方法回顾分析68例妊娠合并PH患者的临床资料,根据肺动脉收缩压情况分为轻度组(30～40 mmHg)33例,中度组(41～70 mmHg)23例,重度组(>70 mmHg)12例。比较各组病因、心功能级别、心功能出现恶化的孕周、终止妊娠的时间与方式、母婴结局。结果轻度组及中度组患者心功能以Ⅰ～Ⅱ级为主,分别为63.6%(21/33)和56.5%(13/23),重度组心功能Ⅲ～Ⅳ级者占91.7%(11/12),明显多于轻度组及中度组。68例患者中,以先天性心脏病、风湿性心脏病及妊娠期高血压疾病为主,分别占41.2%(28/68)、19.1%(13/68)和19.1%(13/68)。68例患者中,中期妊娠引产8例(11.8%,其中医源性引产6例),早产21例(30.9%),足月产39例(57.4%)。58例患者(85.3%)行剖宫产术,阴道分娩3例(4.41%)。重度组1例产妇死亡,病死率为1.47%。新生儿死亡2例。重度组早产率及低出生体质量儿率均高于轻中度组。结论肺动脉压力越高,孕产妇心功能情况及母婴结局越差。应根据患者情况综合判断终止妊娠的时机,剖宫产手术终止妊娠是较安全的分娩方式。
Objective To analyse the clinical characteristics of pulmonary hypertension（PH） complicating pregnancy, and to explore the delivery time and the way. Methods Clinical data of 68 cases of pregnant women with pulmonary hypertension from Jan 2009 to Dec 2012 were analyzed and they were divided into three groups according to the systolic pressure of the pulmonary artery： 33 cases of slight group （from30 to 40 mmHg）, 23 cases of moderate group （from 41 to 70 mmHg） and 12 cases of severe group（higher than 70 mmHg）. The cause of pulmonary hypertension, cardiac functional status, gestational weeks of deterioration with heart function and pregnancy termination, mode of delivery and outcomes of infants and the mothers were compared between the groups. Results The rate of NYHA class I ~ ~ was 63.6% （21/33） in slight group and 56.5%（13/23） in moderate group. The rate of NYHA class m - IV was 91.7%（11/12） in severe group. The most common causes of PH were congenital heart disease, rheumatic heart disease and hypertensive disorders in pregnancy. The outcomes of the 68 cases were： induction of labor in second trimester in 8 cases （11.8%, including 6 cases for iatrogenic abortion）, preterm labor in 21 cases （30.9%）, and term delivery in 39 cases（57.4%）. The rate of cesarean section was 85.3%（58/68）,and 1 was vaginal delivery（4.41%）. The rate of death was 1.47%（ 1/68 ）. Two infants was dead. Conclusion The rate of heart failure increases gradually with the severity of pulmonary hy- pertension. The rate of maternal mortality and fetal loss increases in pregnant women with pulmonary hypertension. Cesarean section is safe to terminate pregnancy.
出处
《安徽医学》
2013年第6期701-704,共4页
Anhui Medical Journal
关键词
妊娠
肺动脉高压
临床特点
Pregnancy
Pulmonary hypertension
Clinical characteristics
