2020 年第 7 期 第 15 卷

妊娠合并肺动脉高压死亡患者的临床特征及妊娠结局分析

Clinical characteristics and pregnancy outcome of pregnant patients died of pulmonary hypertension during pregnancy 

作者：袁媛1高瑞雪2范琍2张军1宋丽军3龚静1

英文作者：Yuan Yuan1 Gao Ruixue2 Fan Li2 Zhang Jun1 Song Lijun3 Gong Jing1 

单位：1首都医科大学附属北京安贞医院妇产科100029；2首都医科大学附属北京安贞医院护理部100029；3首都医科大学附属北京安贞医院神经外科100029 

英文单位：1Department of Obstetrics and Gynecology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China； 2Department of Nursing Beijing Anzhen Hospital Capital Medical University Beijing 100029 China； 3Department of Neurosurgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：妊娠；肺动脉高压；心功能；新生儿

英文关键词：Pregnancy；Pulmonaryhypertension；Cardiacfunction；Fetus

• 摘要：

• 目的探讨妊娠合并肺动脉高压（PAH）死亡患者的临床特征及其妊娠结局。方法回顾性分析2009年1月至2019年9月首都医科大学附属北京安贞医院收治的23例妊娠合并PAH死亡患者的临床资料及其妊娠结局。未及终止妊娠抢救无效死亡2例，经阴道分娩3例，子宫下段剖宫产18例，其中2例在剖宫产后进行了双侧输卵管绝育术。总结患者基本资料和手术指标，基本资料包括年龄，发热、初产妇、定期产检比例，既往心脏病手术史，产前纽约心脏病协会心功能分级、PAH严重程度、妊娠风险等级；手术指标包括术中出血量、术后重症监护病房时间和住院时间。比较21例患者分娩前后心肌酶指标水平的变化，以及18例剖宫产患者术前、术中、术后体循环动脉压的变化，分析23例患者的妊娠结局。结果23例患者年龄17～41岁，平均（29±6）岁，初产妇14例、经产妇9例，定期产检13例，发热13例，有心脏病手术史10例，产前纽约心脏病协会心功能分级Ⅲ级1例、Ⅳ级22例，心脏病妊娠风险等级均为Ⅳ级，中度PAH 1例、重度PAH 22例。18例剖宫产手术中平均出血量(266±201)ml，术后重症监护病房停留时间2（1，7）d，住院时间4（2，10）d。胎死腹内2例，余21例患者产后肌酸激酶和超敏肌钙蛋白I水平均显著高于产前［164(81,1 775)U/L比 35（31,43）U/L，0.52（0.05,2.02）U/L比0.01（0.00,0.05）U/L］，差异均有统计学意义（均P＜0.05）。18例行子宫下段剖宫产患者术前、术中和术后的收缩压、舒张压比较，差异均无统计学意义（均P＞0.05）。新生儿存活15例，出生10 min内Apgar评分为8～10分。结论肌酸激酶和超敏肌钙蛋白I升高或可作为妊娠合并PAH患者不良预后的初步预测指标，临床应加强心肌酶指标的监测。

• ObjectiveTo explore the clinical features and pregnancy outcomes of patients died of pulmonary hypertension (PAH) during pregnancy. Methods From January 2009 to September 2019, the clinical data and pregnancy outcome of 23 patients in Beijing Anzhen Hospital, Capital Medical University who died of PAH during pregnancy were analyzed retrospectively. Two patients were died after failed termination of pregnancy. Three cases were delivered by vagina and 18 cases by cesarean section in the lower part of uterus. The basic data and surgical indicators of patients were Summarized. The basic data included age, fever, primipara, the proportion of regular delivery, previous history of cardiac disease surgery, cardiac function classification of New York Society of Cardiology before delivery, PAH severity, pregnancy risk level； surgical indicators included intraoperative hemorrhage, postoperative intensive care unit（ICU） time and hospitalization time. The changes of myocardial enzymes before and after delivery were compared in 21 patients, and the changes of systemic arterial pressure before, during and after cesarean section in 18 patients. Results  The 23 patients were 17-41 years old, with an average age of (29±6)years. There were 14 primiparas, 9 primiparas, 13 cases with regular birth examination, 13 cases with fever, 10 cases with history of cardiac surgery. Heart function classification of New York Heart Association before delivery were 1 case of grade Ⅲ, 22 cases of grade Ⅳ. All patients had a grade Ⅳ risk of heart disease pregnancy, with moderate PAH (1 case) and severe PAH (22 cases). The average bleeding volume in 18 cases of cesarean section was (266±201)ml, the postoperative intensive care unit stay time was 2(1, 7)d, and hospitalization time was 4(2,10)d. The postpartum creatine kinase and hypersensitive troponin I levels of the remaining 21 patients were significantly higher than those of prenatal［164(81,1 775)U/L vs 35(31,43)U/L, 0.52(0.05,2.02)U/L vs 0.01(0.00,0.05)U/L］, the differences were statistically significant(both P<0.05). There was no significant difference in systolic and diastolic blood pressure(P>0.05). Fifteen neonates survived, and Apgar score was 8-10 points within 10 min of birth.Conclusion Increased creatine kinase and high-sensitivity troponin I may be used as a preliminary predictor of poor prognosis in patients with pregnancy combined with PAH, and clinical monitoring of myocardial enzyme indicators should be strengthened.