2025 年第 6 期 第 20 卷

合并重度肺动脉高压孕产妇的临床特征及妊娠结局分析

Analysis of the clinical characteristics and pregnancy outcomes of pregnant women with severe pulmonary hypertension

作者：陆育秋 张军张大伟

英文作者：Lu Yuqiu Zhang Jun Zhang Dawei

单位：首都医科大学附属北京安贞医院妇产科/心血管重症妇产医学中心，北京100029

英文单位：Department of Obstetrics and Gynecology Cardiovascular Critical Care Obstetrics and Gynecology Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：妊娠并发症；心血管；肺动脉高压；妊娠结局；多学科管理

英文关键词：Pregnancycomplications;Cardiovascular;Pulmonaryhypertension;Pregnancyoutcomes; Multi-disciplinarymanagement

• 摘要：

• 目的 探讨合并重度肺动脉高压（PH）孕产妇的临床特征和妊娠结局。方法 回顾性分析首都医科大学附属北京安贞医院2018年1月至2023年12月收治的40例合并重度PH孕产妇的临床资料。考虑此类患者相关指标与心功能有一定相关性，故按照心功能分级对40例患者进行相关情况总结、其中心功能Ⅱ级20例、Ⅲ级13例、Ⅳ级7例。收集孕产妇的分娩年龄、孕产次、孕期和出院前B型脑钠肽（BNP）升高及血小板计数（PLT）下降患者比例、足月妊娠比例、分娩孕周等及母儿结局进行分析。结果 40例患者中初产妇36例、经产妇4例，36例患者孕期及围产期使用利尿补钾类药物。40例患者中孕期BNP升高共18例（45.0%），心功能Ⅱ、Ⅲ、Ⅳ级患者中各占6例；出院前6例恢复正常，心功能越差的患者BNP升高的比例越高、出院前恢复正常的比例越低。心功能越差，PLT下降的比例越高。40例患者中足月妊娠（孕周≥37周）6例（15.0%），心功能Ⅱ、Ⅲ、Ⅳ级患者中分别占5、1、0例，心功能分级高者足月妊娠比例低。极早产2例（5.0%），心功能Ⅱ、Ⅲ、Ⅳ级患者中分别占1、0、1例，心功能Ⅳ级患者极早产占比较高。心功能Ⅱ、Ⅲ、Ⅳ级患者的分娩孕周分别为（33.0±3.1）、（32.5±3.2）、（32.9±3.0）周，经多学科协作诊治管理不同心功能分级患者中各有1例孕产妇死亡。新生儿死亡1例，孕产妇为心功能Ⅲ级患者；新生儿窒息4例，心功能Ⅱ、Ⅲ、Ⅳ级患者中分别占2、1、1例。结论 妊娠合并重度PH对母儿有严重不良影响，通过多学科协作诊治管理，可使其获得更好的妊娠结局。

• Objective To investigate the clinical characteristics and pregnancy outcomes of pregnant women with severe pulmonary hypertension (PH). Methods The clinical data of 40 pregnant women with severe PH admitted to Beijing Anzhen Hospital, Capital Medical University from January 2018 to December 2023 were retrospectively analyzed. Considering that there was a certain correlation between related indicators and cardiac function, 40 patients were summarized according to the classification of cardiac function, including 20 cases of grade Ⅱ, 13 cases of grade Ⅲ, and 7 cases of grade Ⅳ. Maternal age, gravidity and parity time, the proportion of patients with increased brain natriuretic peptide (BNP) and decreased platelet count (PLT) during pregnancy and before discharge, the proportion of full-term pregnancy, gestational age at delivery and maternal and fetal outcomes were collected and analyzed. Results Among the 40 patients, 36 were primiparas and 4 were multiparas. The 36 patients used diuretics and potassium supplement drugs during pregnancy and perinatal period. BNP increased in 18 cases (45.0%) of 40 patients in the second trimester, including 6 cases with cardiac function grade Ⅱ, Ⅲ and Ⅳ, respectively. Six patients recovered to normal before discharge, and the higher the proportion of BNP elevation in patients with poorer cardiac function, the lower the proportion of patients who recovered to normal before discharge. The worse the cardiac function, the higher the proportion of PLT decline. Among the 40 patients, 6 cases (15.0%) were full-term pregnant (gestational age ≥37 weeks), and there were 5, 1, and 0 patients with cardiac function class Ⅱ, Ⅲ, and Ⅳ, respectively. The proportion of full-term pregnancy was low in patients with higher cardiac function class. Two cases (5.0%) were extremely premature, accounting for 1, 0, and 1 respectively among patients with cardiac function grades Ⅱ, Ⅲ, and Ⅳ. Patients with heart function grade Ⅳ had a higher proportion of extremely premature births. The gestational weeks of delivery for patients with cardiac function grades Ⅱ, Ⅲ, and Ⅳ were (33.0±3.1), (32.5±3.2), and (32.9±3.0) weeks, respectively. Through multidisciplinary collaborative diagnosis and treatment management, there was 1 maternal death among patients with different functional classifications. One newborn died, and the pregnant woman had a cardiac function grade Ⅲ patient; there were 4 cases of neonatal asphyxia, with 2, 1, and 1 cases of cardiac function grade Ⅱ, Ⅲ, and Ⅳ patients, respectively. Conclusion Pregnancy with severe PH has serious adverse effects on mother and fetus. Better pregnancy outcomes can be achieved through multidisciplinary collaborative diagnosis and management.