Guo X Y, Shao H, Zhao Y Y
Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2018 Oct 18;50(5):928-931.
To investigate the pathophysiology, screening, diagnosis and treatment of the systemic lupus erythematosus (SLE) in pregnancy complicated with pulmonary hypertension. Retrospective analysis was made of one case of SLE in pregnancy complicated with pulmonary hypertension in Peking University Third Hospital. Literature was reviewed to investigate the pathophysiology, screening, diagnosis and treatment of the SLE in pregnancy complicated with pulmonary hypertension. SLE is an autoimmune mediated diffuse connective tissue disease characterized by immunological inflammation. The incidence of SLE combined with pulmonary hypertension was low, but the risk was high with pregnancy, with a high perinatal mortality rate. Pulmonary hypertension is the leading cause of the death in patients with pregnancy complicated with SLE. This patient was diagnosed with SLE six years before and was hospitalized for 29 weeks of menopause, with fatigue five months and chest congestion one month. Ultrasonic cardiogram showed severe pulmonary hypertension, with pulmonary arterial systolic pressure being 96 mmHg. After admission, multidisciplinary consultation was organized to draw up a diagnosis and treatment plan. The patient received the treatment of rest,oxygen,blood gas and pulmonary artery pressure monitoring. Considering perioperative pulmonary hypertension crisis likely to occur, pulmonary artery catheter was placed preoperatively. In general anesthesia, the cesarean was performedfter operation,the patient was transferred to the intensive care unit, with the treatment of expanding blood vessels, reducing pulmonary artery pressure,administering anticoagulation and preventing infection. Ten days after operation, the patient was discharged from hospital with smooth condition. Strengthening the management of SLE patients in pregnancy, early detection, and cooperation of multidisciplinary teams can help improve maternal and fetal outcomes. Termination of pregnancy should be offered to the patients with severe pulmonary hypertension. Right cardiac catheterization is the gold standard for diagnosing pulmonary hypertension. Some patients are diagnosed in later stage of pregnancy, regular antenatal examination, interdisciplinary co-operation, assessment of cardiac function, monitoring the condition of the pregnant woman and fetus and timely termination of pregnancy are needed. Epidural anesthesia is the appropriate choice for cesarean delivery.
探讨妊娠合并肺动脉高压的系统性红斑狼疮（SLE）的病理生理、筛查、诊断及治疗。回顾性分析北京大学第三医院1例妊娠合并肺动脉高压的SLE患者。查阅文献探讨妊娠合并肺动脉高压的SLE的病理生理、筛查、诊断及治疗。SLE是一种以免疫炎症为特征的自身免疫介导的弥漫性结缔组织病。SLE合并肺动脉高压的发生率低，但妊娠时风险高，围产儿死亡率高。肺动脉高压是妊娠合并SLE患者死亡的主要原因。该患者6年前诊断为SLE，停经29周入院，5个月来乏力，1个月来胸闷。超声心动图示重度肺动脉高压，肺动脉收缩压96 mmHg。入院后组织多学科会诊制定诊治方案。患者接受了休息、吸氧、血气及肺动脉压监测等治疗。考虑到围手术期可能发生肺动脉高压危象，术前放置肺动脉导管。在全身麻醉下行剖宫产术，术后患者转入重症监护病房，给予扩血管、降低肺动脉压、抗凝及预防感染等治疗。术后10天患者病情平稳出院。加强妊娠合并SLE患者的管理，早期发现，多学科团队协作有助于改善母婴结局。重度肺动脉高压患者应终止妊娠。右心导管检查是诊断肺动脉高压的金标准。部分患者在妊娠晚期确诊，需定期产检、多学科合作、评估心功能、监测孕妇及胎儿情况并及时终止妊娠。剖宫产时硬膜外麻醉是合适的选择。
