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目的:探讨临床风湿性心脏病合并肺动脉高压的妊娠病例临床特征及治疗后的妊娠结局。方法:选取我院2013年5月与2015年5月收治风湿性心脏病与肺动脉高压合并发生的妊娠患者40例,回顾性分析其临床资料。结果:轻度肺高压17例,中度10例,重度13例。随肺动脉压力呈升高显示时,对心功能评估,表现为恶化,提示心功能评定结果与肺动脉压力检查结果呈正相关。本组应用二尖瓣球囊扩张术(PBMV)7例,瓣膜置换术10例,非手术23例。瓣膜置换与非手术比较,肺动脉压力明显降低(P<0.05)。PBMV相较非手术组,肺动脉压力在PBMV术后明显降低(P<0.05)。均采用剖宫产,足月分娩率、早产率对比,各组差异有统计学意义(P<0.05),随着肺动脉高压不断增加,临床早产率或(和)流产率也呈增加趋势。重度肺高压产妇中,本组死亡1例。结论:妊娠风湿性心脏病合并肺动脉高压时,在治疗上相对棘手,需在妊娠前对心功能积极改善,依据需要应用手术方案;而已患病例,需综合分析心功能状态、瓣膜性质,制定治疗方案,以获得理想的妊娠结局。
Objective: To investigate the clinical features of pregnancy in clinical rheumatic heart disease complicated with pulmonary hypertension and the pregnancy outcome after treatment. Methods: Forty patients with pregnancy complicated by rheumatic heart disease and pulmonary hypertension were selected from May 2013 to May 2015 in our hospital. The clinical data were retrospectively analyzed. Results: 17 cases of mild pulmonary hypertension, 10 cases of moderate, severe in 13 cases. As pulmonary artery pressure was elevated, assessment of cardiac function showed worsening, suggesting that cardiac function assessment results and pulmonary artery pressure test results were positively correlated. The group of mitral balloon dilation (PBMV) in 7 cases, valve replacement in 10 cases, 23 cases of non-surgical. Compared with non-surgical valve replacement, pulmonary artery pressure was significantly lower (P <0.05). Compared with non-operation PBMV group, pulmonary artery pressure was significantly lower after PBMV (P <0.05). Cesarean section, full-term delivery rate, premature birth rate were compared, the differences were statistically significant (P <0.05). With the continuous increase of pulmonary hypertension, the clinical preterm birth rate and / or miscarriage rate also increased. Severe pulmonary hypertension maternal death in this group in 1 case. Conclusions: In the case of rheumatic heart disease complicated with pulmonary hypertension, it is relatively difficult to treat, and it is necessary to improve the heart function positively before pregnancy and apply the surgical plan according to the need. In the case of already suffering from the disease, the cardiac function state and the nature of the valve should be comprehensively analyzed Treatment options to achieve the desired pregnancy outcome.