妊娠合并心脏病伴肺动脉高压患者的妊娠结局探讨

摘要

ObjectiveTo discuss the outcomes of pregnancy with heart disease complicating with pulmonary hypertension.Method50 pregnant women with heart disease complicating pulmonary hypertension, who were treated in our hospital from January 2006 to July 2014 were retrospectively analyzed. According to the systolic pressure of pulmonary artery, they were divided into mild group (14 cases), moderate group (15 cases) and severe group (21 cases). Oxygen partial pressure, oxygen saturation, ratio of pulmonary artery systolic blood pressure and systemic systolic blood pressure (Pp/Ps), perinatal infants and pregnancy outcomes were monitored before therapy.ResultCardiac function gradeⅠ of patients in mild and moderate group were more than severe group, cardiac function gradeⅣ patients were less than severe group (P<0.05). The oxygen partial pressure, oxygen saturation, blood platelet level in severe group were lower than mild and moderate group, the Pp/Ps was signiifcantly higher than mild and moderate group (P<0.05). The term delivery and neonatal birth weight in severe group were lower than mild and moderate group, premature birth, medical abortion, neonatal asphyxia, maternal heart failure occurrence rate were higher than mild and moderate group (P<0.05); the term delivery, premature birth, neonatal birth weight had significant differences between mild group and moderate group (P<0.05), and iatrogenic abortion, neonatal asphyxia, maternal heart failure occurred rate had no significant differences (P>0.05).ConclusionPulmonary hypertension complicating with heart disease in pregnant women is a dangerous factor for both mother and infant. The higher the pulmonary artery pressure, the higher the rate of maternal mortality, premature delivery, abortion rate and low birth weight. The active treatment in pregnant women with heart disease complicating mild and moderate pulmonary hypertension could obtain satisfactory clinical outcomes.%目的：探讨妊娠合并心脏病伴肺动脉高压患者的妊娠结局。方法回顾性分析2006年1月至2014年7月本院妇产科收治的50例中晚期妊娠合并心脏病伴肺动脉高压患者的临床资料，按肺动脉高压程度分为轻度组（14例）、中度组（15例）、重度组（21例）。观察并比较三组患者氧分压、氧饱和度、血小板计数、肺动脉收缩压与体循环收缩压比值（Pp/Ps）及围生儿与妊娠结局。结果轻、中度组心功能Ⅰ级患者多于重度组，心功能Ⅳ级患者少于重度组（P＜0.05）。重度组患者氧分压、氧饱和度、血小板计数较轻、中度组明显降低，Pp/Ps较轻、中度组明显升高（P＜0.05）。重度组足月分娩及新生儿出生体重均低于轻、中度组（P＜0.05），早产、医源性流产、新生儿窒息、孕妇心力衰竭发生率均高于轻、中度组（P＜0.05）；轻度组与中度组足月分娩、早产、新生儿出生体重比较差异均具有显著性（P＜0.05），而医源性流产、新生儿窒息、孕妇心力衰竭发生率比较差异均无显著性（P＞0.05）。结论心脏病伴肺动脉高压是母婴安全的高危因素。肺动脉压力越高，孕产妇的死亡率、早产率、流产率及低体重儿出生率越高。但对于轻、中度肺动脉高压孕妇经过积极处理仍有望获得满意的妊娠结局。