84例妊娠合并肺高血压患者预后的临床分析

doi:10.6040/j.issn.1671-7554.0.2020.0513

摘要/Abstract

摘要： 目的回顾性分析84例妊娠合并肺高血压(PH)患者临床资料,为患者的治疗方案及预后评估提供依据。方法回顾性分析2017年10月至2019年9月于广州医科大学附属第三医院治疗的妊娠合并PH的84例患者资料。分析在特发性肺动脉高压(iPAH)、先天性心脏病相关肺动脉高压(CHD-PAH)、左心疾病所致肺高血压(LHD-PH)、未知因素所致肺高血压(oPAH)4种不同临床分类中,年龄、妊娠时间、世界卫生组织(WHO)功能、肺动脉收缩压、分娩方式、住院天数、转入ICU、住院费用、并发症、孕产妇死亡率和婴儿死亡率各指标的异同;将患者按临床分类分为iPAH组、CHD-PAH组、LHD-PH组和oPAH组,按肺动脉收缩压分为≥90 mmHg组、70~89 mmHg组, 50~69 mmHg组和30~49 mmHg组,按WHO功能分为WHO功能Ⅰ、Ⅱ、Ⅲ、Ⅳ组,分析不同分组中各类患者的预后及分组的优劣。对数据的统计学处理主要采用单因素方差分析、秩和检验及精确概率检验分析。结果 84例妊娠合并PH的患者中,以iPAH、CHD-PAH、LHD-PH、oPAH这4种临床分类为主。按临床分类,iPAH组、CHD-PAH组、LHD-PH组和oPAH组患者的WHO功能分级和肺动脉收缩压的总体差异有统计学意义(P均<0.001)。4组间孕产妇死亡率总体差异有统计学意义(P<0.001),其中iPAH组高于CHD-PAH组(P=0.006)、LHD-PH组(P<0.001)、oPAH组(P=0.004);4组间转入ICU率的总体差异有统计学意义(P=0.001),其中iPAH组高于LHD-PH组(P=0.001)、oPAH组(P=0.009);按肺动脉收缩压分组,4组的孕产妇死亡率总体差异有统计学意义(P<0.001),其中≥90 mmHg组高于30~49 mmHg组(P<0.001)、50~69 mmHg组(P=0.015);4组间转入ICU率的总体差异有统计学意义(P<0.001),其中≥90 mmHg组高于30~49 mmHg组(P<0.001)、50~69 mmHg组(P=0.044),70~89 mmHg组高于30~49 mmHg组(P<0.001);按WHO功能分组,4组间的孕产妇死亡率、转入ICU率和住院费用的总体差异有统计学意义(P=0.013,P<0.001,P=0.008),其中WHO功能Ⅳ级组均高于WHO功能Ⅰ级组(P=0.046,P=0.003,P=0.040)。结论妊娠合并PH患者中,iPAH患者的预后较差,需做好术前准备,必要时应做好启动体外膜肺氧合的准备。而对预后的评估,应该结合临床类型、肺动脉压力以及WHO心功能来判断,这样可以更准确地判断且提前做好治疗方案。

关键词: 妊娠, 肺高血压, 预后, 管理

Abstract: Objective To analyze the clinical data of 84 pregnant women with pulmonary hypertension(PH)retrospectively, and to provide evidence for the treatment plan and prognosis assessment of the patients. Methods A total of 84 pregnant women with PH who hospitalized in The Third Affiliated Hospital of Guangzhou Medical University from October 2017 to September 2019 were enrolled. The difference of clinical data, including age, gestational age, WHO functional class, pulmonary artery systolic pressure, mode of delivery, inpatient days, ICU admission, cost of treatment, the incidence of complications, maternal death and fetal death, in idiopathic pulmonary arterial hypertension(iPAH)group, pulmonary arterial hypertension associated with congenital heart disease(CHD-PAH)group, pulmonary hypertension caused by left heart disease(LHD-PH)group and pulmonary arterial hypertension associated with other disease(oPAH)group were analyzed. Then the patients were grouped by three ways, including clinical conditions, pulmonary artery systolic pressure and World Health Organization(WHO)functional class, and the prognosis was comparied. The One-Way ANOVA test, Kruskal-Wallis H test and Fishers exact test analyses were mainly used for statistical analysis of data. Results Most of pregnant women with PH were iPAH, CHD-PAH, LHD-PH, and oPAH types. Grouped by clinical conditions, WHO functional class and pulmonary artery systolic pressure were statistically different on the whole for the iPAH, CHD-PAH, LHD-PH, and oPAH groups(both P<0.001). The rates of mortality in the four groups were statistically different on the whole, in which iPAH group was higher than CHD-PAH group(P=0.006), LHD-PH group(P<0.001)and oPAH group(P=0.004). The ICU admission in the four groups were statistically different on the whole, in which iPAH group was higher than LHD-PH group(P=0.001)and oPAH group(P=0.009). Grouped by pulmonary arterial systolic blood pressure, the mortality were statistically different on the whole for ≥90 mmHg group, 70-89 mmHg group, 50-69 mmHg group and 30-49 mmHg group(P<0.001), in which ≥90 mmHg group was higher than 30-49 mmHg group(P<0.001)and 50-69 mmHg group(P=0.015); the ICU admissions in the four groups were statistically different on the whole(P<0.001), in which 90 mmHg group was higher than 30-49 mmHg group(P<0.001)and 50-69 mmHg group(P=0.044), and 70-89 mmHg group was higher than 30-49 mmHg group(P<0.001). Grouped by WHO function, the mortality, ICU admission and hospitalization costs were statistically different on the whole(P=0.013,P<0.001,P=0.008),in which WHO function Ⅳ grade group was higher than WHO function Ⅰ grade group(P=0.046,P=0.003,P=0.040). Conclusion Outcomes of pregnant women with PH are poor in iPAH type, the preoperative preparation, maybe extracorporeal membrane oxygenation(ECMO)should be made. The clinical conditions, pulmonary artery systolic pressure, and WHO functional class should be considered in assessment of the patients outcomes.

Key words: Pregnancy, Pulmonary hypertension, Outcomes, Management

中图分类号:

R574

贾明旺,廖广园,熊明媚,徐文婷,王银玲,王懿春. 84例妊娠合并肺高血压患者预后的临床分析[J]. 山东大学学报 (医学版), 2021, 59(1): 34-39.

JIA Mingwang, LIAO Guangyuan, XIONG Mingmei, XU Wenting, WANG Yinling, WANG Yichun. Clinical analysis of outcomes of 84 pregnant women with pulmonary hypertension[J]. Journal of Shandong University (Health Sciences), 2021, 59(1): 34-39.

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