摘要
目的 探讨妊娠合并肺动脉高压(PAH)病人的临床特征及影响妊娠结局的因素.方法 回顾性分析2016年1月-2023年1月就治于我院的125例妊娠合并PAH病人的临床资料.根据动脉收缩压分组,其中轻度PAH组58例,中度PAH组42例,重度PAH组25例.比较3组病人的一般临床资料、心功能分级、病因及妊娠结局,分析不同程度的PAH病人出现不良妊娠结局的危险因素.结果 3组病人孕前超重、定期产检、合并艾森曼格综合征、心悸、胸闷、氨基末端B型利钠肽前体(NT-proBNP)异常、口唇发绀等指标比较,差异有统计学意义(x2=4.926～34.000,P＜0.05).PAH的严重程度与病人的心功能分级有关(H=20.678,P＜0.05).重度PAH组的分娩孕周、新生儿窒息率、胎儿生长受限率、孕妇及新生儿转重症监护室率、孕产妇呼吸衰竭和病死率、住院时间、住院费用均高于轻度PAH组(x2=6.246～30.854,F=7.601～11.447,P＜0.05).单因素分析结果显示,未定期产检、重度PAH、心功能Ⅲ～Ⅳ级、NT-proBNP异常和心悸是不良妊娠结局的危险因素(OR=3.874～17.250,95％CI=(1.626～5.710)～(9.232～77.253),P＜0.01);多因素分析结果显示,重度PAH、心功能Ⅲ～Ⅳ级和心悸为不良妊娠结局独立的危险因素(OR=10.772～17.189,95％CI=(2.043～4.031)～(37.437～101.305),P＜0.01).结论 妊娠期PAH病人的妊娠结局与肺动脉压力呈反比.轻度PAH且心功能＜Ⅲ级、无心悸的孕妇可尽量延长孕周至足月,重度PAH、心功能Ⅲ～Ⅳ级或心悸的孕妇发生不良妊娠结局的风险较高,必要时及时终止妊娠是降低孕产妇病死率以及改善母婴结局的关键.
Abstract
Objective To investigate the clinical features of pregnant women with pulmonary arterial hypertension(PAH)and the influencing factors for pregnancy outcome.Methods A retrospective analysis was performed for the clinical data of 125 pregnant women with PAH who were treated in our hospital from January 2016 to January 2023,and according to the systolic blood pressure,they were divided into mild PAH group with 58 patients,moderate PAH group with 42 patients,and severe PAH group with 25 patients.The three groups were compared in terms of general clinical data,cardiac functional grade,etiology,and pregnancy outcome,and the risk factors for adverse pregnancy outcome were analyzed for patients with different degrees of PAH.Results There were significant differences between the three groups in overweight before pregnancy,regular antenatal examina-tion,comorbidity with Eisenmenger syndrome,palpitation,chest distress,abnormal N-terminal pro-brain natriuretic peptide(NT-proBNP),and cyanosis of lips(x2=4.926-34.000,P＜0.05).The severity of PAH was significantly correlated with the cardiac functional grade of patients(H=20.678,P＜0.05).Compared with the mild PAH group,the severe PAH group had significantly higher gestational weeks at the time of delivery,significantly higher rates of neonatal asphyxia and fetal growth restriction,signifi-cantly higher rates of admission to the intensive care unit for pregnant women and neonates,significantly higher respiratory failure and mortality rates of pregnant and parturient women,a significantly longer length of hospital stay,and significantly higher hospi-tal costs(x2=6.246-30.854,F=7.601-11.447,P＜0.05).The univariate analysis showed that the lack of regular antenatal examination,severe PAH,grade Ⅲ-Ⅳ cardiac function,abnormal NT-proBNP,and palpitation were risk factors for adverse pregnancy outcomes(OR=3.874-17.250,95％CI=1.626-5.710 to 9.232-77.253,P＜0.01),and the multivariate analysis showed that severe PAH,grade Ⅲ-Ⅳ cardiac function,and palpitation were independent risk factors for adverse pregnancy outcomes(OR=10.772-17.189,95％CI=2.043-4.031 to 37.437-101.305,P＜0.01).Conclusion The pregnancy outcome of PAH patients is inversely proportional to pulmonary artery pressure.Pregnant women with mild PAH,cardiac functional grade＜m,and ab-sence of palpitation can extend the gestational week to term as far as possible,while pregnant women with severe PAH,grade Ⅲ-Ⅳ cardiac function,or palpitation have a higher risk of adverse pregnancy outcomes.Timely termination of pregnancy when neces-sary is the key to reducing maternal mortality and improving maternal and infant outcomes.
维普
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