82例妊娠合并肺动脉高压孕妇的临床分析

Clinical Analysis in 82 Pregnant Women with the Severity of Pulmonary Hypertension

摘要: 目的：探讨妊娠合并不同程度肺动脉高压(PAH)患者的临床特点和妊娠结局。方法：回顾性分析青岛大学附属医院崂山院区产科2020年1月至2023年1月收治的82例妊娠合并肺动脉高压患者的临床资料。根据PAH严重程度分为：轻度PAH (30~49 mmHg)、中度PAH (50~79 mmHg)、重度PAH (≥80 mmHg)，比较各组PAH孕妇的分娩时机、方式和母婴结局。结果：1) 合并轻、中、重度PAH各组患者年龄、平均住院时间比较无统计学差异(p > 0.05)，轻度PAH组孕妇平均分娩孕周大于中、重度PAH组(p < 0.05)。2) 合并轻、中、重度PAH各组患者剖宫产率大于阴道分娩率(p > 0.05)，PAH患者行剖宫产手术时椎管内麻醉率大于全身麻醉率(p > 0.05)。3) 合并、中、重度PAH各组患者产后出血量无统计学差异(p > 0.05)；术后转重症监护室(ICU)率和术后心衰发生率及新生儿低体重率具有统计学差异(p < 0.05)。4) 三组新生儿早产率及新生儿窒息率无统计学差异(p > 0.05)；新生儿低体重率具有统计学差异(p < 0.05)。结论：妊娠合并PAH严重威胁母婴安全，孕期规律、全程产检和适时终止妊娠对改善妊娠结局有关键作用。

Abstract: 0bjective: To investigate clinical characteristics and pregnancy outcomes of pregnant patients with pulmonary arterial hypertension (PAH). Methods: A retrospective study was conducted on 82 cases of pregnant women complicated with pulmonary hypertension who delivered in the Affiliated Hos-pital of Qingdao University from 2020.1 to 2023.1. The cases were divided into three groups ac-cording to the severity of pulmonary hypertension: mild PAH group (30~49 mmHg), moderate PAH group (50~79 mmHg), severe PAH group (≥80mmHg). The timing of delivery, mode of delivery and pregnancy outcomes were compared between these three groups. Results: 1) There was no signifi-cant difference in the average age and timing in the hospital of mild, moderate and severe PAH group (p > 0.05). Gestational age of mild PAH group was later than the other two groups (p < 0.05). 2) The cesarean section rate was higher than the vaginal delivery rate in these three groups (p > 0.05). The rate of neuraxial anesthesia was more than that of general anaesthetic when cesarean section was conducted in these three groups (p > 0.05). 3) The postpartum hemorrhage of patients with the severity of PAH was similar in these three groups (p > 0.05). But the rates of admission of intensive care unit (ICU) and postoperative heart failure were significantly different in three groups (p < 0.05). 4) The rates of premature labor and neonatal asphyxia were similar in these three groups (p > 0.05). But the rate of neonatal low weight was significantly different in three groups (p < 0.05). Con-clusions: Pregnancy complicated with PAH is a severe threat to maternal and fetal health. Regular and full-course prenatal examinations during pregnancy and timely termination of pregnancy can enhance the outcomes of pregnancy.