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