妊娠合并肺动脉高压的早期识别及管理

doi:10.12280/gjfckx.f20200974

摘要/Abstract

摘要：

妊娠合并肺动脉高压（pulmonary hypertension）是一类严重危及母儿生命的妊娠合并症,目前任何原因引起的肺动脉高压均被列为妊娠禁忌证。孕产妇死亡多与肺动脉高压危象、右心衰竭、栓塞有关,对胎儿的影响主要包括胎死宫内、流产、早产、胎儿生长受限等。肺动脉高压妇女妊娠后,早期临床症状不典型,易与妊娠状态混淆,对早期识别提出挑战。超声心动图具有方便、简单、无创及无辐射等特性,可作为高危人群筛查手段。妊娠合并肺动脉高压一经诊断,应转至具有相关管理经验的母胎医疗中心,注重个体化管理及多学科团队协作,结合母胎情况,决定分娩时机、方式及麻醉方式,降低母儿风险,保障母婴安全。

关键词: 高血压,肺性, 妊娠, 产前诊断, 孕产妇健康

Abstract:

Pregnancy with pulmonary hypertension is a life-threatening disease to both maternal and fetal. Pulmonary hypertension is currently listed as a pregnancy contraindication, no matter what the primary causes. Maternal deaths are mostly related to pulmonary hypertension crisis, right heart failure, and embolism. The main impacts on the fetus include intrauterine death, miscarriage, premature delivery, and fetal growth restriction. After pregnancy, women with pulmonary hypertension often have no obvious clinical symptoms in the early stage, and they are easily confused with pregnancy status, which poses challenges for early recognition. Echocardiography, which is convenient, simple, non-invasive and non-radiation, can be used as a screening method for high-risk populations. Once pregnant patients with pulmonary hypertension are diagnosed, they should be transferred to a maternal and fetal medicine center, with relevant management experience. Individualized management and multidisciplinary teamwork should be emphasized, and the timing, method and anesthesia method of delivery should be determined based on the maternal and fetal conditions to reduce the risks and ensure the safety.

Key words: Hypertension,pulmonary, Pregnancy, Prenatal diagnosis, Maternal health

史天一, 贡颖颖, 钱惠勤, 于红. 妊娠合并肺动脉高压的早期识别及管理[J]. 国际妇产科学杂志, 2021, 48(4): 367-370.

SHI Tian-yi, GONG Ying-ying, QIAN Hui-qin, YU Hong. The Early Recognition and Management of Pregnancy with Pulmonary Hypertension[J]. Journal of International Obstetrics and Gynecology, 2021, 48(4): 367-370.

图/表 2

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三尖瓣反流速度	是否有PH超声表现	提示PH可能性
≤2.8 m/s或测不出	否	低级
≤2.8 m/s或测不出	是	中级
2.9~3.4 m/s	否	中级
2.9~3.4 m/s	是	高级
>3.4 m/s	不需要	高级

三尖瓣反流速度	是否有PH超声表现	提示PH可能性
≤2.8 m/s或测不出	否	低级
≤2.8 m/s或测不出	是	中级
2.9~3.4 m/s	否	中级
2.9~3.4 m/s	是	高级
>3.4 m/s	不需要	高级

A：心室	B：肺动脉	C：下腔静脉及右心房
右心室/左心室内径比>1.0	多普勒右心室流出加速时间<105 ms和（或）收缩中期喀喇音	下腔静脉直径>21 mm,吸气时塌陷（深吸气时塌陷率<50%或平静吸气时塌陷率<20%）
室间隔展平[收缩期和（或）舒张期左心室偏心指数>1.1]	舒张早期肺动脉反流速度>2.2 m/s 肺动脉直径>25 mm	右房面积（收缩末期>18 cm²）

A：心室	B：肺动脉	C：下腔静脉及右心房
右心室/左心室内径比>1.0	多普勒右心室流出加速时间<105 ms和（或）收缩中期喀喇音	下腔静脉直径>21 mm,吸气时塌陷（深吸气时塌陷率<50%或平静吸气时塌陷率<20%）
室间隔展平[收缩期和（或）舒张期左心室偏心指数>1.1]	舒张早期肺动脉反流速度>2.2 m/s 肺动脉直径>25 mm	右房面积（收缩末期>18 cm²）