患有分流相关性先天性心脏病合并肺动脉高压的孕妇的母儿结局：一项回顾性研究
Maternal outcomes among pregnant women with shunt-related congenital heart disease-associated pulmonary hypertension: a retrospective study.
作者信息
Sun Tiantian, Che Hao, Zhang Jun, Lv Yufang, Liu Yaguang, Liu Daqi, Wu Jinjing, Wang Sheng, Zhao Liyun
机构信息
Department of Anesthesiology, Anzhen Hospital, Beijing Medical Center for Critical Pregnancy, Capital Medical University, 2 Anzhen Road, Beijing, 100029, China.
Department of Obstetrics and Gynaecology, Anzhen Hospital, Beijing Medical Center for Critical Pregnancy, Capital Medical University, 2 Anzhen Road, Beijing, 100029, China.
出版信息
BMC Anesthesiol. 2025 Jul 1;25(1):299. doi: 10.1186/s12871-025-03082-2.
BACKGROUND
Studies on pregnant women with shunt-related congenital heart disease (CHD)-associated pulmonary hypertension (PH) are scarce and limited by small sample sizes. This study aimed to describe the outcomes of pregnant women.
METHODS
Outcomes of pregnant women with shunt-related CHD-associated PH were retrospectively evaluated from 2010 to 2020. PH was diagnosed based on echocardiography. The incidence of maternal death and postoperative vasoactive drug therapy were compared between women with mild-to-moderate and severe PH. The characteristics and factors influencing postoperative vasoactive drug therapy in women with severe PH were studied. Postoperative vasoactive drug therapy was defined as the use of vasoactive drugs for over 48 h after cesarean section or abortion to maintain circulatory stability.
RESULTS
A total of 255 pregnant patients with shunt-related CHD-associated PH were enrolled, including 147 with mild-to-moderate pulmonary artery systolic pressure (PASP) of 30-70 mmHg and 108 with severe PH (PASP > 70 mmHg). Overall, women with mild-to-moderate PH had better maternal outcomes than those with severe PH, including the incidence of maternal mortality (0.68% vs. 11.11%, P < 0.001) and postoperative vasoactive drug therapy (2.74% vs. 50.47%, P < 0.001). Gestational week at delivery (OR 0.9, 95% CI[0.82,0.98], P = 0.016), Eisenmenger syndrome (OR 2.64, 95% [1.08,6.64], P = 0.034), and New York Heart Association (NYHA) functional class III to IV (OR 5.22, 95% [1.90,14.35], P < 0.001) were independently associated with postoperative vasoactive drug therapy in pregnant women with severe PH.
CONCLUSIONS
Women with shunt-related CHD-associated mild to moderate PH had better outcomes than those with severe PH in terms of the incidence of maternal mortality and postoperative vasoactive drug therapy. Multimodal risk assessment, including PH severity, gestational week, Eisenmenger syndrome, and NYHA functional class, may be useful for risk stratification in pregnant women with shunt-related CHD-associated PH.
背景
关于患有分流相关性先天性心脏病（CHD）合并肺动脉高压（PH）的孕妇的研究较少，且受样本量小的限制。本研究旨在描述此类孕妇的结局。
方法
回顾性评估2010年至2020年患有分流相关性CHD合并PH的孕妇的结局。基于超声心动图诊断PH。比较轻度至中度和重度PH患者的孕产妇死亡发生率及术后血管活性药物治疗情况。研究重度PH患者术后血管活性药物治疗的特征及影响因素。术后血管活性药物治疗定义为剖宫产或流产后使用血管活性药物超过48小时以维持循环稳定。
结果
共纳入255例患有分流相关性CHD合并PH的孕妇，其中147例轻度至中度肺动脉收缩压（PASP）为30 - 70 mmHg，108例为重度PH（PASP > 70 mmHg）。总体而言，轻度至中度PH患者的孕产妇结局优于重度PH患者，包括孕产妇死亡率（0.68%对11.11%，P < 0.001）及术后血管活性药物治疗（2.74%对50.47%，P < 0.001）。分娩孕周（OR 0.9，95% CI[0.82,0.98]，P = 0.016）、艾森曼格综合征（OR 2.64，95%[1.08,6.64]，P = 0.034）和纽约心脏协会（NYHA）功能分级III至IV级（OR 5.22，95%[1.90,14.35]，P < 0.001）与重度PH孕妇术后血管活性药物治疗独立相关。
结论
在孕产妇死亡率及术后血管活性药物治疗发生率方面，患有分流相关性CHD合并轻度至中度PH的女性结局优于重度PH患者。包括PH严重程度、分娩孕周、艾森曼格综合征和NYHA功能分级在内的多模式风险评估，可能有助于对患有分流相关性CHD合并PH的孕妇进行风险分层。
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