王艳虹

[摘要] 目的:探讨妊娠合并肺动脉高压的临床表现、诊断和治疗。方法:回顾分析2例妊娠合并肺动脉高压患者的临床资料。结果:第1例患者为妊娠合并继发性肺动脉高压,孕35周剖宫产,术后5 d出现胸闷、呼吸困难、发绀,最终抢救无效死亡,临床考虑肺小动脉栓塞。第2例为双胎合并原发性肺动脉高压,因孕34+2周,双胎,活动后胸闷、心悸1周入院。于孕35周剖宫产,产后胸闷、心悸一度加重,经对症治疗好转,产后3周平安出院。结论:妊娠合并肺动脉高压母儿结局不良,患者不宜妊娠。一旦妊娠应早期终止。拒绝终止妊娠者,应加强监护,尤其要监测肺动脉高压和低氧血症的情况。

[关键词] 肺动脉高压;妊娠并发症;诊断;治疗

[中图分类号]R714.24+6 [文献标识码] B[文章编号] 1673-7210(2009)07(a)-197-02

Diagnosis and treatment of pulmonary hypertension during pregnancy

WANG Yanhong

(Department of Gynecology and Obstetrics, General Hospital of Puyang Oil Field, Puyang 457001, China)

[Abstract] Objective:To investigate clinical presentation,diagnosis and treatment of pulmonary hypertension during pregnancy.Methods:Two patients with pulmonary hypertension during pregnancy were reported retrospectively. Results:The first case was secondary pulmonary hypertension during pregnancy. Cesarean Section was performed at 35 weeks. She had chest distress, dyspnea and cyanosis after five days, and died finally. The diagnosis of pulmonary embolism was highly suspected clinically. The second case was admitted because of twin pregnancy and chest distress, palpitation during daily life for one week. She was primary pulmonary hypertension. Cesarean Section was performed at 35 weeks. The chest distress and palpitation worsened after Cesarean Section. The above-mentioned symptoms improved after expectant treatment. She was discharged from the hospital three weeks after delivery. Conclusion:Pulmonary hypertension during pregnancy was associated with extremely poor maternal and fatal outcome. Pregnancy is contraindicated in such patients. Pregnancy should be terminated as early as possible in such women. In case who intends to continue the pregnancy,close observation,especially of pulmonary hypertension and hypoxemia,must be provided.

[Key words]Pulmonary hypertension; Pregnancy complications; Diagnosis; Therapy

心脏病肺动脉高压(pulmonary hypertension, PH), 包括原发性肺动脉高压(primary pulmonary hypertension,PPH)和继发性肺动脉高压。原发性肺动脉高压是指原因不明的肺动脉高压,继发性肺动脉高压是指除外PHH外,所有其他类型的有原因可寻的肺动脉高压,如风心病、先心病等。妊娠合并心脏病肺动脉高压是一种较少见的疾病,严重威胁母儿生命。现报道我院2例妊娠合并肺动脉高压,以引起产科医生的重视。

1临床资料

第1例:患者26岁,孕3产0,孕36+5周,活动后胸闷、心悸、发绀2个月入院。自幼青紫,偶有心悸、气促,日常生活能自理。2002年在郑州空军医院诊为先天性心脏病(室缺、动脉导管未闭、肺动脉高压)。当时在该院行开胸手术,关闭动脉导管,因肺动脉高压严重,未行室缺修补。……