妊娠与肺动脉高压的研究现状

Research Status of Pregnancy and Pulmonary Arterial Hypertension

摘要: 肺动脉高压(PAH)是一种进行性疾病，其特征是血管收缩，血栓形成以及平滑肌和内皮细胞增殖的不可逆的肺血管变化，可导致右心负荷增大和右心功能不全，最终可导致患者死亡。妊娠合并肺动脉高压的发生率大约为1.1/10万，尽管随着临床技术的不断进展，但其病死率仍可高达30%~56%。肺循环不良，母胎长期缺氧使其母体并发症(心力衰竭、心律失常、咯血、神经系统事件、感染、肺血栓栓塞、产后出血)、新生儿并发症(早产、畸形、宫内发育迟缓)明显高于正常孕妇。本文将从妊娠合并肺动脉高压定义和分类、病理生理、治疗、分娩的方式与麻醉方式的选择等方面进行综述。

Abstract: Pulmonary arterial hypertension (PAH) is a progressive disease characterized by vasoconstriction, thrombosis, and irreversible pulmonary vascular changes in smooth muscle and endothelial cell proliferation that can lead to increased right cardiac load and right cardiac dysfunction, which can ultimately lead to patient death. The incidence of pulmonary arterial hypertension in pregnancy is about 1.1/100,000, and despite the continuous progress of clinical technology, the fatality rate can still be as high as 30%~56%. Due to poor pulmonary circulation and chronic maternal and fetal hypoxia, maternal complications (heart failure, arrhythmia, hemoptysis, nervous system events, infection, pulmonary thromboembolism, postpartum hemorrhage) and neonatal complications (premature delivery, malformation, intrauterine growth retardation) are significantly higher than those of normal pregnant women. This article will review the definition and classification of pregnancy with pulmonary arterial hypertension, pathophysiology, treatment, delivery mode and anesthesia mode.