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肺动脉高压孕产妇病因及妊娠结局分析

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目的 探究妊娠合并肺动脉高压的原发病因构成,分析患者的妊娠结局及其相关影响因素,为指导该类患者孕期管理提供新的循证医学数据.方法 选取于北部战区总医院终止妊娠的肺动脉高压孕产妇57例,根据患者肺动脉高压严重程度将其分为轻度组(26例)、中度组(20例)及重度组(11例),选择同期肺动脉压力正常的孕产妇138例作为对照组.收集并比较各组孕产妇的临床资料,分析肺动脉高压原发病因构成、不同严重程度肺动脉高压患者的妊娠结局及其相关影响因素.结果 先天性心脏病(CHD)是肺动脉高压孕产妇的主要原发病因,占63.2%.不同组别复杂型CHD患者比例比较,差异有统计学意义(P<0.05).重度组心功能Ⅲ~Ⅳ级的患者比例高于对照组和轻、中度组,差异有统计学意义(P<0.05);重度组心电图异常的患者比例高于轻度组和对照组,差异有统计学意义(P<0.05).对照组和轻度组的足月活婴分娩率高于中、重度组,差异有明显统计学意义(P<0.05);重度组死胎率高于其他组,差异有统计学意义(P<0.05);对照组和轻度组新生儿窒息率低于中、重度组,差异有统计学意义(P<0.05);对照组及轻度组新生儿出生体质量高于中、重度组,差异有统计学意义(P<0.05).结论 妊娠合并肺动脉高压最常见的原发病因是CHD.轻、中度肺动脉高压孕产妇出现不良妊娠结局的风险较重度肺动脉高压孕产妇低.可利用多普勒二维超声评估、孕产妇肺动脉压力监测及时给予干预,改善妊娠及胎儿结局.
Etiology and pregnancy outcome of pregnant women with pulmonary hypertension
Objective To explore the primary etiology of pregnancy complicated with pulmonary hypertension,analyze the pregnancy outcome and related influencing factors of patients,and provide new evidence-based medical data for guiding the pregnancy management of these patients.Methods A total of 57 pregnant women with pulmonary hypertension who terminated their pregnancy in the General Hospital of Northern Theater Command were selected and divided into the mild group(26 cases),the moderate group(20 cases)and the severe group(11 cases)according to the severity of pulmonary hypertension,and 138 pregnant women with normal pulmonary artery pressure during the same period were selected as the control group.The clinical data of pregnant women in all groups were collected and compared,and the primary etiology of pulmonary hypertension,the pregnancy outcome of patients with different severity of pulmonary hypertension and its related influencing factors were analyzed.Results Congenital heart disease(CHD)was the main primary etiology of pregnant women with pulmonary hypertension,accounting for 63.2%.There was significant difference in the proportion of patients with complex CHD in different groups(P<0.05).The proportion of patients with grade Ⅲ to Ⅳ heart function in the severe group was significantly higher than those in the control group,the mild group and the moderate group,with statistically significant differences(P<0.05).The proportion of patients with abnormal electrocardiogram in the severe group was higher than those in the mild group and the control group,and the differences were statistically significant(P<0.05).The delivery rate of full-term live infants in the control group and the mild group were much higher than those in the moderate group and the severe group,and the differences were statistically significant(P<0.05).The stillbirth rate in the severe group was higher than those in the other groups,and the differences were statistically significant(P<0.05).The neonatal asphyxia rate in the control group and the mild group were lower than those in the moderate group and the severe group,and the differences were statistically significant(P<0.05).The birth weight of newborns in the control group and the mild group were higher than those in the moderate group and the severe group,and the differences were statistically significant(P<0.05).Conclusion The most common primary etiology of pregnancy complicated with pulmonary hypertension is CHD.Pregnant women with mild or moderate pulmonary hypertension have lower risk of adverse pregnancy outcomes than pregnant women with severe pulmonary hypertension.Doppler two-dimensional ultrasound evaluation and monitoring of pulmonary artery pressure of pregnant women can be used to intervene in time to improve pregnancy and fetal outcome.

pregnancypulmonary hypertensionetiologypregnancy outcome

张程程、张金慧、曲冬颖

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北部战区总医院妇产科,辽宁 沈阳 110003

仓乐县人民医院妇产科,山东 潍坊 262400

妊娠 肺动脉高压 病因 妊娠结局

辽宁省科技厅民生科技计划联合计划项目

2021JH2/10300095

2024

局解手术学杂志
重庆市解剖学会,第三军医大学

局解手术学杂志

CSTPCD
影响因子:1.063
ISSN:1672-5042
年,卷(期):2024.33(8)
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