妊娠合并先天性心脏病伴肺动脉高压79例妊娠结局分析

目的分析妊娠合并先天性心脏病伴肺动脉高乐患者的妊娠结局。方法回顾性分析2009年1月至2013年6月北京安贞医院妇产科收治的79例妊娠合并先天性心脏病伴肺动脉高压患者的临床资料，根据肺动脉压力将其分为轻度组、中度组、重度组。分析各组先天性心脏病种类、心功能级别、终止妊娠的方式以及母婴结局。结果先心病类型以房间隔缺损（房缺）和室间隔缺损（室缺）为主，肺动脉高压轻度组心功能以Ⅰ～Ⅱ级为主，重度组心功能以Ⅲ～Ⅳ级为主。79例患者中，行医源性流产者16例（20．8％），经阴道分娩5例（6．5％），剖宫产56例（72．7％）。重度组医源性流产率高于其他组，足月分娩率低于其他组，差异有统计学意义（P〈0．05）。新生儿早产20例（32．8％），足月产41例（67．2％），死产1例，随着肺动脉压力的增加，早产的发生率增加，三组之间相互比较差异有统计学意义（P〈0．05）。结论肺动脉高压患者应在妇产科及心脏科医师指导下妊娠，不宜妊娠者应及早终止妊娠。孕产妇终止妊娠方式以剖宫产为主，麻醉方式以硬膜外麻醉为宜。

The analysis of pregnancy outcome in 79 pregnant women with pulmonary hypertension complicating congenital heart disease

Objective Explore the pregnancy outcome and treatment of women with pulmonary hypertension complicating congenital heart disease. Methods Clinical data of 79 cases of pregnant women with pulmonary hypertension complicating congenital heart disease who were treated in Anzhen Hospital from Jan 2009 to Jun 2013 were analyzed retrospectively. Patients were divided into 3 groups according to the pulmonary pressure： slight pulmonary hypertension group, moderate group and severe group. The types of congenital heart disease, cardiac functional sta tus, mode of pregnancy termination and outcomes of infants were compared between the groups. Results The most common types of congenital heart disease were atrial septal defect and ventricular septal defect. The cardiac status of slight pulmonary hypertension group was mostly distributed in NYHA class Ⅰ - Ⅱ , while severe group in NYHA class Ⅲ -Ⅳ. There were 16 patients （20. 8%） received iatrogenic abortion, 5 patients （6.50/oo） delivered by vagina and 56 patients （72.7%） underwent caesarean section. The rate of iatrogenic abortion in severe group was apparently higher than that of another groups, while the rate of term delivery was lower than another groups. The difference was significant （P〈0.05）. And there were 20 premature births （32.8%）, 41 term deliveries （67.2%） and 1 newborn death. The rate of premature birth was increased with the increasing of the pulmonary pressure. The difference was statistically significant between every two groups （P〈0. 05）. Conclusions Patients with pulmonary hypertension complicating congenital heart disease should not be pregnant before inquiring cardiologist and obstetrician and terminate the pregnancy as soon as possible if it is not allowed. Surgery is a safe delivery method to termi nate pregnancy and epidural anesthesia is preferred for surgery.