[1]杜珊珊 文莉 封盼攀 黄玮.妊娠合并肺动脉高压的研究进展[J].心血管病学进展,2025,(6):499.[doi:10.16806/j.cnki.issn.1004-3934.2025.06.005]
 DU Shanshan,WEN Li,FENG Panpan,et al.Pulmonary Hypertension with Pregnancy[J].Advances in Cardiovascular Diseases,2025,(6):499.[doi:10.16806/j.cnki.issn.1004-3934.2025.06.005]
点击复制

妊娠合并肺动脉高压的研究进展()

《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2025年6期
页码:
499
栏目:
综述
出版日期:
2025-06-25

文章信息/Info

Title:
Pulmonary Hypertension with Pregnancy
作者:
杜珊珊 文莉 封盼攀 黄玮
(重庆医科大学附属第一医院心血管内科,重庆 400016)
Author(s):
DU ShanshanWEN LiFENG PanpanHUANG Wei
(Department of Cardiology,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016 ,China)
关键词:
肺动脉高压妊娠靶向治疗多学科团队母胎/婴预后
Keywords:
Pulmonary hypertension Pregnancy Targeted therapy Multidisciplinary team Maternal and fetal/newborn outcomes
DOI:
10.16806/j.cnki.issn.1004-3934.2025.06.005
摘要:
妊娠合并肺动脉高压(PH)是一种高危产科疾病,可能导致母婴不良结局。妊娠期生理变化加重患者右心负担,导致病情恶化。近年来妊娠合并PH的发病率逐步升高,尽管治疗进展使死亡率有所下降,但目前指南仍不建议PH患者妊娠。妊娠患者的管理和治疗应由多学科团队合作完成,重点包括专科咨询、围生期管理、右心衰竭管理及PH靶向治疗。分娩方式需要综合考虑母婴状况。体外膜肺氧合等终末期治疗方法为临床提供了更多选择。未来研究应进一步探索妊娠合并PH的病理机制及治疗策略。
Abstract:
Pulmonary hypertension (PH) with pregnancy is a high-risk condition that can result in adverse maternal and fetal outcomes. Pregnancy-induced physiological changes increase the right heart load ,exacerbating the condition. While the mortality of PH with pregnancy has decreased due to advancements in treatment. However,current guidelines continue to against PH with pregnancy patients. Management should be provided by a multidisciplinary team,focusing on specialist consultation,right heart failure management,and targeted therapy for pulmonary arterial hypertension. Delivery methods should be chosen based on maternal and fetal condition. End-stage treatments,such as extracorporeal membrane oxygenation,provide additional therapeutic options. Future research is needed to further investigate the pathophysiology and treatment approaches for pregnancy complicated by PH

参考文献/References:

[1] Humbert M,Kovacs G,Hoeper MM,et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension[J]. Eur Heart J,2022,43(38):3618-3731.

[2] Hemnes AR,Kiely DG,Cockrill BA,et al. Statement on pregnancy in pulmonary hypertension from the pulmonary vascular research institute[J]. Pulm Circ,2015,5(3):435-465.

[3] Kang Y,Jiang X. Pregnancy outcomes and risk factors of serious cardiovascular adverse events in pregnant women with pulmonary hypertension[J]. Int J Surg,2024,110(3):1850-1852.

[4] Chen Y,Zhou D,Xiong M,et al. Prediction and prognosis of adverse maternal and foetal/neonatal outcomes in pulmonary hypertension:an observational study and nomogram construction[J]. Respir Res,2022,23(1):314.

[5] Ma R,Gao H,Cui J,et al. Pregnancy feasibility in women with mild pulmonary arterial hypertension:a systematic review and meta-analysis[J]. BMC Pregnancy Childbirth,2023,23(1):427.

[6] Fan C,Liu X,Liu R,et al. Pregnancy conditions and outcomes of Chinese women with mild,moderate and severe pulmonary arterial hypertension[J]. Hypertens Res,2024,47(9):2561-2573.

[7] Miao H,Chen Y,Wang C,et al. Pregnancies in women with moderate and severe pulmonary hypertension remain challenging:A single-center experience in East China[J]. Int J Gynecol Obste,2022,157(1):140-148.

[8] Sliwa K,van Hagen IM,Budts W,et al. Pulmonary hypertension and pregnancy outcomes:data from the Registry Of Pregnancy and Cardiac Disease ( ROPAC ) of the European Society of Cardiology[J]. Eur J Heart Fail,2016,18(9):1119-1128.

[9] Chen W,Luo J,Chen J,et al. Effect of multidisciplinary team (MDT) centred on pregnant women with pulmonary hypertension on treatment and outcomes of pregnancy[J]. BMC Pulm Med,2023,23(1):62.

[10] Zhang Q,Zhu F,Shi G,et al. Maternal outcomes among pregnant women with congenital heart disease-associated pulmonary hypertension[J]. Circulation,2023,147(7):549-561.

[11] Liu Y,Li H,Li Y,et al. Outcomes of pregnancy in women with different types of pulmonary hypertension[J]. BMC Cardiovasc Disord,2023,23(1):391.

[12] Wang W,Wang L,Feng P,et al. Real-world in-hospital outcomes and potential predictors of heart failure in primigravid women with heart disease in Southwestern China[J]. BMC Pregnancy Childbirth,2020,20(1):372.

[13] Potnuru PP,Jefferies H,Lei R,et al. Maternal pulmonary hypertension and cardiopulmonary outcomes during delivery hospitalization in the United States:a nationwide study from 2016 -2020[J]. Pregnancy Hypertens,2024,38:101170.

[14] Agrawal A,Bajaj S,Bhagat U,et al. Cardiovascular complications with delivery hospitalizations in patients with pulmonary hypertension:a nationwide study from 2011 to 2020[J]. JAHA,2024,13(11):e031632.

[15] Low T,Guron N,Ducas R,et al. Pulmonary arterial hypertension in pregnancy—a systematic review of outcomes in the modern era[J]. Pulm Circ,2021,11(2):1-9.

[16] Roos-Hesselink J,Baris L,Johnson M,et al. Pregnancy outcomes in women with cardiovascular disease:evolving trends over 10 years in the ESC Registry Of Pregnancy And Cardiac disease(ROPAC)[J]. Eur Heart J,2019,40(47):3848-3855.

[17] Preston IR,Howard LS,Langleben D,et al. Management of pulmonary hypertension in special conditions[J]. Eur Respir J,2024,64(4):2401180.

[18] Liu Y,Li Y,Zhang J,et al. Pregnancy outcomes of women with Eisenmenger syndrome:a single-center study[J]. Int J Cardiol ,2023,374:35-41.

[19] Liu Y,Li Y,Zhang J,et al. Maternal and fetal outcomes of pregnant women with pulmonary arterial hypertension associated with congenital heart disease in Beijing,China:A retrospective study[J]. Pulm Circ,2022,12(2):e12079.

[20] Lv C,Wu L,Liao G,et al. Maternal and fetal/neonatal outcomes of pregnancies complicated by pulmonary hypertension:a retrospective study of 154 patients[J]. Clinics,2023,78:100194.

[21] Angelopoulos A,Farrell R. PH professional network:genetic counseling and pulmonary arterial hypertension[J]. Adv Pulm Hypertens,2021,20(5):164-167.

[22] van Giersbergen PLM,Halabi A,Dingemanse J. Pharmacokinetic interaction between bosentan and the oral contraceptives norethisterone and ethinyl estradiol[J]. Int J Clin Pharmacol Ther,2006,44(3):113-118.

[23] Lakshminrusimha S,Abman SH. Oxygen targets in neonatal pulmonary hypertension[J]. Clin Perinatol,2024,51(1):77-94.

[24] 中华医学会呼吸病学分会肺栓塞与肺血管病学组,中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会,全国肺栓塞与肺血管病防治协作组,等. 中国肺动脉高压诊断与治疗指南(2021版)[J]. 中华医学杂志,2021,101(1):11-51.

[25] van der Zande JA,Greutmann M,Tobler D,et al. Diuretics in pregnancy:data from the ESC registry of pregnancy and cardiac disease (ROPAC)[J]. Eur J Heart Fail,2024,26(7):1561-1570.

[26] Regitz-Zagrosek V,Roos-Hesselink JW,Bauersachs J,et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy[J]. Eur Heart J,2018,39(34):3165-3241.

[27] S?rbye IK,Haualand R,Wiull H,et al. Maternal beta-blocker dose and risk of small-for gestational-age in women with heart disease[J]. Acta Obstet Gynecol Scand,2022,101(7):794-802.

[28] 中华医学会妇产科学分会产科学组.妊娠期及产褥期静脉血栓栓塞症预防和诊治专家共识[J].中华妇产科杂志,2021,56(4):236-243.

[29] 杨彩华,杨龙娜,李小波. 妊娠早期暴露低剂量华法林钠片后致胎儿畸形2例分析[J].中国药物警戒,2023,20(11):1286-1289.

[30] Wang T,Lu J,Li Q,et al. Rapid titration of intravenous treprostinil to treat severe pulmonary arterial hypertension postpartum:a retrospective observational case series study[J]. Anesth Analg ,2019,129(6):1607-1612.

[31] Perisetla N,Miranda C,Louis J,et al. Inhaled epoprostenol via high-flow nasal cannula and intravenous treprostinil for management of severe pulmonary arterial hypertension during cesarean delivery with epidural anesthesia:a case report[J]. Int J Obstet Anesth ,2024,61:104295.

[32] Hoeper MM,Badesch DB,Ghofrani HA,et al. Phase 3 trial of sotatercept for treatment of pulmonary arterial hypertension[J]. N Engl J Med,2023,388(16):1478-1490.

[33] Ming Y,Wu Z,Wu Z,et al. Effects of different anesthesia methods on maternal and neonatal outcomes in pregnant patients with pulmonary arterial hypertension:a meta-analysis[J]. Arch Gynecol Obstet,2022,306(1):7-15.

[34] 中华医学会妇产科学分会产科学组. 妊娠合并心脏病的诊治专家共识(2016)[J].中华妇产科杂志,2016,51(6):401-409.

[35] Kamp JC,von Kaisenberg C,Greve S,et al. Pregnancy in pulmonary arterial hypertension:Midterm outcomes of mothers and offspring[J]. J Heart Lung Transplant,2021,40(3):229-233.

相似文献/References:

[1]孟晓冬,单福祥,综述,等.肺动脉高压治疗进展[J].心血管病学进展,2016,(3):319.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.028]
 MENG Xiaodong,SHAN Fuxiang,WANG Yanhui.Advances in Research of Pulmonary Hypertension[J].Advances in Cardiovascular Diseases,2016,(6):319.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.028]
[2]张艺韬,综述,曾伟杰,等.左心疾病相关肺动脉高压流行病学[J].心血管病学进展,2016,(4):333.[doi:10.16806/j.cnki.issn.1004-3934.2016.04.002]
 ZHANG Yitao,ZENG Weijie,CHENG Kanglin.Epidemiology of Pulmonary Hypertension due to Left Heart Disease[J].Advances in Cardiovascular Diseases,2016,(6):333.[doi:10.16806/j.cnki.issn.1004-3934.2016.04.002]
[3]汪汉,刘英杰,王燕凤.长链非编码RNA与肺动脉高压[J].心血管病学进展,2019,(6):898.[doi:10.16806/j.cnki.issn.1004-3934.2019.06.015]
 WANG Han,LIU Yingjie,WANG Yanfeng.Long Non-coding RNA in Pulmonary Arterial Hypertension[J].Advances in Cardiovascular Diseases,2019,(6):898.[doi:10.16806/j.cnki.issn.1004-3934.2019.06.015]
[4]汪汉 邓祁 刘英杰.系统性红斑狼疮相关肺动脉高压的诊断、治疗及预后[J].心血管病学进展,2019,(8):1142.[doi:10.16806/j.cnki.issn.1004-3934.2019.08.018]
 WANG Han,DENG Qi,LIU Yingjie.Diagnosis,Treatment and Prognosis of Pulmonary Arterial Hypertension in Systemic Lupus Erythematosus[J].Advances in Cardiovascular Diseases,2019,(6):1142.[doi:10.16806/j.cnki.issn.1004-3934.2019.08.018]
[5]段宇 贾静 步睿 李涛 韦宏.急性伊洛前列素吸入对肺动脉高压患者右心室功能的影响[J].心血管病学进展,2019,(9):1319.[doi:10.16806/j.cnki.issn.1004-3934.2019.09.034]
 DUAN Yu,JIA Jing,BU Rui,et al.The Effect of Acute Iloprost Inhalation on Right Ventricular Function in Pulmonary Arterial Hypertension[J].Advances in Cardiovascular Diseases,2019,(6):1319.[doi:10.16806/j.cnki.issn.1004-3934.2019.09.034]
[6]查玉杰 何庆.肺动脉高压发生发展中的相关因子[J].心血管病学进展,2020,(2):192.[doi:10.16806/j.cnki.issn.1004-3934.2020.02.024]
 ZHA YujieHE Qing.The Relevant Factors in the Development of Pulmonary Hypertension[J].Advances in Cardiovascular Diseases,2020,(6):192.[doi:10.16806/j.cnki.issn.1004-3934.2020.02.024]
[7]朱珊英,朱国斌.肺动脉高压发病机制新进展[J].心血管病学进展,2020,(3):292.[doi:10.16806/j.cnki.issn.1004-3934.2020.03.019]
 ZHU Shanying,ZHU Guobin.Pathogenesis of Pulmonary Hypertension[J].Advances in Cardiovascular Diseases,2020,(6):292.[doi:10.16806/j.cnki.issn.1004-3934.2020.03.019]
[8]韩柯,孟祥光,赵育洁.趋化因子及其受体在肺动脉高压中的研究进展[J].心血管病学进展,2020,(3):296.[doi:10.16806/j.cnki.issn.1004-3934.2020.03.020]
 HAN Ke,MENG Xiangguang,ZHAO Yujie.Chemokines and Their Receptors in Pulmonary Arterial Hypertension[J].Advances in Cardiovascular Diseases,2020,(6):296.[doi:10.16806/j.cnki.issn.1004-3934.2020.03.020]
[9]刘超 曲杰 王明娟 徐倩 范彦芳 周晓慧 单伟超.肺动脉高压对扩张型心肌病预后的影响[J].心血管病学进展,2020,(4):424.[doi:10.16806/j.cnki.issn.1004-3934.2020.04.023]
 LIU ChaoQU JieWANG MingjuanXU QianFAN YanfangZHOU XiaohuiSAN Weichao.The Effect of Pulmonary Hypertension on the Prognosis of Dilated Cardiomyopathy[J].Advances in Cardiovascular Diseases,2020,(6):424.[doi:10.16806/j.cnki.issn.1004-3934.2020.04.023]
[10]向杰 刘明鑫 张伟 黄从新.基于生物信息学分析探究肺动脉高压关键基因和通路[J].心血管病学进展,2020,(4):428.[doi:10.16806/j.cnki.issn.1004-3934.2020.04.024]
 Xiang JieLiu MingxinZhang WeiHuang Congxin.Bioinformatics Analysis of Key Genes and Pathways in Pulmonary Arterial Hypertension[J].Advances in Cardiovascular Diseases,2020,(6):428.[doi:10.16806/j.cnki.issn.1004-3934.2020.04.024]
[11]房晨鹂?铁馨 刘元汉.妊娠合并肺动脉高压的发病机制及性激素的作用[J].心血管病学进展,2021,(7):625.[doi:10.16806/j.cnki.issn.1004-3934.2021.07.012]
 FANG Chenli,TIE Xin,LIU Yuanhan,et al.The Pathogenesis of Pregnancy with Pulmonary Hypertension and the Role of Sex Hormones[J].Advances in Cardiovascular Diseases,2021,(6):625.[doi:10.16806/j.cnki.issn.1004-3934.2021.07.012]

更新日期/Last Update: 2025-07-31