李珊珊,周红梅,张刚成

• 1:武汉亚洲心脏病医院先天性心脏病中心

摘要(Abstract)：

目的分析和总结妊娠合并特发性肺动脉高压(IPAH)患者的临床资料及治疗效果。方法回顾性分析2012年1月到2013年12月武汉亚洲心脏病医院收治的8例妊娠合并IPAH患者(妊娠组),将同期IPAH患者中非妊娠的18例患者作为对照(非妊娠组)。比较两组患者临床资料、实验室检查和心导管检查结果,评价IPAH的治疗效果和预后。结果两组患者年龄、性别、体重、气促、黑矇、咯血、发绀、心包积液、Brog评分等比较,差异均无统计学意义(均P>0.05)。妊娠组晕厥(2/8比0,P=0.027)及水肿(8/8比4/18,P<0.001)比例显著高于非妊娠组;妊娠组患者初诊时世界卫生组织肺动脉高压功能(WHO-FC)分级Ⅲ级(5/8)、Ⅳ级(2/8)居多,非妊娠组以Ⅱ级(13/18)居多,组间比较差异有统计学意义(P=0.004)。妊娠组患者三尖瓣反流速度[(4.19±0.57)m/s比(4.78±0.68)m/s,P=0.042]、心脏指数[(1.74±0.51)L/(min·m~2)比(2.62±0.79)L/(min·m~2),P=0.030]小于非妊娠组,而左心室收缩末期内径[(3.21±0.58)cm比(2.16±0.67)cm,P=0.001]大于非妊娠组,差异均有统计学意义。8例妊娠组患者急性肺血管扩张试验均为阴性,除1例失访外,其余7例随访14～30(17.38±9.52)个月。2例患者因经济原因仅在住院期间使用靶向肺血管扩张药,其中1例因肺动脉高压危象死亡,另1例WHO-FC由Ⅲ级及降为Ⅳ级;5例接受规律靶向肺血管扩张药,其中1例死亡,1例效果不佳,3例心功能改善。3例心功能改善患者治疗后12个月复查脑钠肽下降了(287±256)pg/ml,6 min步行距离试验平均距离增加了(43.0±10.4)m,Borg呼吸困难评分降低了(1.8±1.6)分。结论妊娠可缩短既往无症状IPAH患者的疾病进程并对生命造成严重危害。坚持继续妊娠的患者早期足量使用靶向肺血管扩张药可改善妊娠合并IPAH的预后。

关键词(KeyWords)： 妊娠;肺动脉高压;右心导管;肺血管扩张药

Abstract:

Keywords:

基金项目(Foundation): 国家“十二五”科技支撑项目(2011BAI11B15);; 武汉市卫生局计生委项目(WX16Z10)

作者(Author): 李珊珊,周红梅,张刚成

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