2024 年第 11 期 第 19 卷

肺动脉收缩压对妊娠合并分流性先天性心脏病相关肺动脉高压患者预后的影响

Effect of systolic pulmonary arterial pressure on the prognosis of pregnant women with shunt-related congenital heart disease-associated pulmonary hypertension

作者：孙甜甜车昊吕誉芳刘亚光刘达琪赵丽云

英文作者：Sun Tiantian Che Hao Lyu Yufang Liu Yaguang Liu Daqi Zhao Liyun

单位：首都医科大学附属北京安贞医院麻醉中心，北京100029

英文单位：Anesthesia Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：分流性先天性心脏病；妊娠；肺动脉高压；术后药物治疗

英文关键词：Shunt-relatedcongenitalheartdisease;Pregnancy;Pulmonaryhypertension;Postoperativedrugtherapy

• 摘要：

• 目的 阐明肺动脉收缩压（SPAP）与妊娠合并分流性先天性心脏病相关肺动脉高压（PH）患者预后的关系。方法 纳入2010年1月至2020年7月首都医科大学附属北京安贞医院254例妊娠合并分流性先天性心脏病相关PH患者的临床资料进行回顾性分析。按是否需要术后药物治疗分为未使用药物治疗组（131例）和药物治疗组（123例）。比较2组基本特征及围手术期管理资料。SPAP依据超声心动图估测，SPAP与术后药物治疗的相关性由回归模型评估并进行曲线拟合以及阈值饱和效应分析。结果 药物治疗组体重指数和孕周均小于、术中输液量少于未使用药物治疗组，纽约心脏病协会心功能分级Ⅲ～Ⅳ级比例、SPAP水平、三尖瓣大量反流比例均高于未使用药物治疗组，差异均有统计学意义（均P<0.001）。在调整了可能的混杂因素后，SPAP与术后药物治疗存在非线性相关性，SPAP的转折点在90 mmHg（1 mmHg=0.133 kPa）。当SPAP≤90 mmHg时，术后药物治疗的风险随着SPAP的升高而增加（比值比=1.06，95%置信区间：1.02～1.09，P=0.001），SPAP＞90 mmHg时，SPAP与术后药物治疗无显著相关性（比值比=0.99，95%置信区间：0.96～1.02，P=0.478）。相对于SPAP≤90 mmHg产妇，SPAP＞90 mmHg者术后药物治疗的风险更高（比值比=3.06，95%置信区间：1.14～8.06，P=0.023）。结论 合并重度PH产妇术后需要药物治疗风险高。对于轻中度患者，需要提高警惕，做好药物治疗准备及尽早改善肺动脉压力以降低妊娠风险。对于这些患者，多因素个体化评估更为重要。

• Objective To investigate the relationship between systolic pulmonary arterial pressure (SPAP) and prognosis in pregnant women with shunt-related congenital heart disease-associated pulmonary hypertension (PH). Methods The clinical data of 254 pregnant women with shunt-related congenital heart disease-associated PH in Beijing Anzhen Hospital, Capital Medical University from January 2010 to July 2020 were retrospectively analyzed. The patients were divided into non-drug treatment group (131 cases) and drug treatment group (123 cases) according to whether they needed postoperative drug treatment. The basic characteristics and perioperative management data of the two groups were compared. SPAP was estimated by echocardiography, and the correlation between SPAP and postoperative medication was evaluated by regression model, curve fitting and threshold saturation effect analysis. Results The body mass index and gestational age of the drug treatment group were less than those of the non-drug treatment group, the intraoperative infusion volume was less than that of the non-drug treatment group, and the proportion of New York Heart Association heart function grades Ⅲ-Ⅳ, SPAP levels, and the proportion of tricuspid valve regurgitation were higher than those in the non-drug treatment group (all P<0.001). After adjusting for possible confounding factors, there was a non-linear correlation between SPAP and postoperative medication, and the turning point of SPAP was 90 mmHg. When SPAP≤90 mmHg, the risk of postoperative drug therapy increased with the increase of SPAP (odds ratio=1.06, 95% confidence interval: 1.02-1.09, P=0.001). When SPAP > 90 mmHg, there was no significant correlation between SPAP and postoperative medication (odds ratio=0.99, 95% confidence interval: 0.96-1.02, P=0.478). Compared with women with SPAP≤90 mmHg, those with SPAP > 90 mmHg have a higher risk of postoperative drug therapy (odds ratio=3.06, 95% confidence interval: 1.14-8.06, P=0.023). Conclusions Puerperae with severe PH have a high risk of requiring drug therapy after surgery. For mild to moderate patients, it is necessary to be vigilant, prepare for drug treatment and improve pulmonary artery pressure as soon as possible to reduce the risk of pregnancy. For these patients, individualized assessment of multiple factors is more important.