妊娠合并重度肺动脉高压28例临床分析

目的:探讨妊娠合并重度肺动脉高压患者的妊娠结局。方法:对2000年11月至2011年3月我院产科收治的28例妊娠合并重度肺动脉高压患者的临床资料进行回顾性分析。根据发生重度肺动脉高压的孕周,将患者分为4组:<28周为Ⅰ组,28～31+6周为Ⅱ组,32～35+6周为Ⅲ组,≥36周为Ⅳ组。结果:原发性肺动脉高压(PPH)1例,继发性肺动脉高压(SPH)27例(风湿性心脏病16例,先天性心脏病11例);心功能Ⅰ～Ⅱ级4例,心功能Ⅲ～Ⅳ级24例;足月分娩12例,早产10例,中孕引产6例;剖宫产21例,阴道分娩1例;产妇死亡2例,极低出生体重儿1例,新生儿窒息5例,新生儿死亡1例。Ⅲ组患者肺动脉压力明显高于Ⅰ组、Ⅳ组,差异有统计学意义(P<0.05);Ⅰ组患者医源性胎儿丢失率明显高于Ⅲ组、Ⅳ组,差异有统计学意义(P<0.05);Ⅳ组患者足月分娩明显多于Ⅱ组、Ⅲ组,差异有统计学意义(P<0.05);新生儿窒息率比较,差异无统计学意义(P>0.05)。结论:妊娠合并重度肺动脉高压患者,孕32～35+6周肺动脉压力达高峰;围生儿结局与发生重度肺动脉高压的孕周、心功能级别有关,发生重度肺动脉高压孕周越小,心功能越差,医源性胎儿丢失率越高,围生儿结局越差;早中期妊娠患者建议尽早终止妊娠,晚期妊娠以剖宫产为宜。

Clinical Analysis of 28 Pregnant Women with Severe Pulmonary Hypertension

Objective:To probe the pregnancy outcome of women with severe pulmonary hypertension.Methods:Clinical data of 28 pregnant women with severe pulmonary hypertension in our hospital from November 2000 to March 2011 were retrospectively analyzed.According to the gestational week of severe pulmonaryhypertension occurrence,patients were divided into four groups:<28 weeks for group I,28～31 +6weeks for group II,32～35 +6 weeks for group III,≥36 weeks for group IV.Results:1 case was primary pulmonary hypertension(PPH),27 case was Secondary pulmonary arterial hypertension(SPH),in which 16 cases were rheumatic heart disease and 11 cases were congenital heart disease.4 cases NYHA class wereⅠ～Ⅱ and 24 cases NYHA class wereⅢ～Ⅳ.12 cases were term delivery,10 cases were premature delivery and 6 cases were induced labor in the second trimester of pregnancy.21 cases were cesarean section,and 1 cases was vaginal delivery.2 mothers were death,1 case was very low birth weight infant,5 cases were neonatal asphyxia and 1 infant was death.The pulmonary artery pressure of group III was higher than group I and group IV,and the difference was statistically significant(P<0.05);Comparing the rate of iatrogenic fetal loss,group I was obviously higher than group III and group IV,the difference was statistically significant (P<0.05);Comparing the rate of term delivery,group IV was obviously higher than group II and group III, the difference was statistically significant(P<0.05);Comparing the rate of neonatal suffocation,there was no significant statistical difference(P>0.05)。Conclusions:At 32～35 +6 weeks,the pulmonary artery pressure is peak in pregnancy with severe pulmonary hypertension.The outcome of perineonate is related with the gestational week when occurring severe pulmonary hypertension and NYHA class.The smaller gestational age and the higher NYHA class,the higher rate of iatrogenic fetal loss,the poorer outcome of perineonate.The patients in the first or second trimester are suggested to terminate pragnancy as early as possible. For the late pregnant patients,cesarean section is more suitable.