摘要： 目的 探讨妊娠合并先天性心脏病伴肺动脉高压(PAH-CHD)孕妇的母婴结局,分析危重主要不良心血管事件(MACE)的独立危险因素。方法 选取2015年1月至2021年2月于中国医科大学附属盛京医院就诊的妊娠合并PAH-CHD孕妇55例。并将其分为左向右分流型先天性心脏病组(n=21)、艾森曼格综合征组(n=20)、先天性心脏病术后组(n=14)。采用χ²检验比较3组孕产妇基本信息特点,肺动脉高压及心功能分级,围产期管理及母婴结局,并进一步采用logistic回归方法分析发生危重MACE的独立危险因素。结果 55例孕妇的平均年龄为(31.4±4.6)岁,3组肺动脉高压分级、终止妊娠孕周、麻醉方式、MACE及新生儿并发症的发生率方面存在统计学差异(P<0.05)。肺动脉压力值、B型利钠肽(BNP)、肌酸激酶同工酶(CK-MB)是发生危重MACE的独立危险因素。结论 妊娠合并PAH-CHD孕产妇的发病率及死亡率仍很高,肺动脉压力值、BNP、CK-MB可能对指导临床治疗及预后有一定的指导作用。

妊娠合并先天性心脏病伴肺动脉高压孕妇的母婴结局

胡思宇, 金镇

中国医科大学附属盛京医院妇产科, 沈阳 110004

收稿日期:2021-09-22出版日期:2022-07-30发布日期:2022-06-27
通讯作者:金镇E-mail:jinzhen66@aliyun.com
作者简介:胡思宇(1996-),女,医师,硕士研究生.



关键词: 肺动脉高压, 妊娠, 先天性心脏病, 主要心血管不良事件, B型利钠肽, 肌酸激酶同工酶
Abstract: Objective To explore the maternal and neonatal outcomes of pulmonary arterial hypertension-associated congenital heart disease (PAH-CHD) and to analyze independent risk factors for critical major adverse cardiovascular events (MACEs). Methods Fifty-five pregnant women with PAH-CHD (31.4±4.6 years) who were treated at the Shengjing Hospital of China Medical University were recruited to this study. The chi-square test was used to compare the patients' basic clinical information characteristics,grading of pulmonary hypertension and cardiac function,and maternal and infant outcomes. Logistic regression was used to further analyze independent risk factors for critical MACE. Results We found significant differences in the grading of pulmonary arterial hypertension,gestational age of pregnancy termination,anesthesia method,incidence of MACE,and neonatal complications among groups (P< 0.05). Pulmonary artery pressure,B-type natriuretic peptide (BNP),and creatine kinase isoenzyme (CK-MB) were independent risk factors for critical MACE. Conclusion The morbidity and mortality of pregnant women with PAH-CHD are very high. Multidisciplinary treatment and management are extremely important to both maternal and fetal health. Pulmonary artery pressure,BNP,and CK-MB may play an important role in guiding clinical treatment and prognosis.
Key words: pulmonary arterial hypertension, pregnancy, congenital heart disease, major adverse cardiac event, brain natriuretic peptide, creatine kinase isoenzyme
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