عنوان انگلیسی مقاله:
Perioperative Management of Pregnant Women With Idiopathic Pulmonary Arterial Hypertension: An Observational Case Series Study From China
ترجمه فارسی عنوان مقاله:
مدیریت بعد از عمل زنان باردار مبتلا به ایدیوپاتیک ریوی فشار خون شریانی: مطالعه موردی مورد بررسی از چین
Sciencedirect - Elsevier - Journal of Cardiothoracic and Vascular Anesthesia,Corrected proof,doi:10.1053/j.jvca.2018.01.043
JinglanZhangMD ، ⁎JiakaiLu، MD†XiaoruiZhou ، MD⁎‡XuefengXu ، MD⁎QingYeMD ، ⁎QitanOuMD ، ⁎YannaLiMD ، § ، JiapengHuangMD, PhD¶
Objectives: The mortality of pregnant women with idiopathic pulmonary arterial hypertension (PAH) is very high. There are limited data on the
management of idiopathic PAH during pregnancy. The authors aimed to examine systematically the characteristics of parturient women with
idiopathic PAH, to explore the adverse effects of idiopathic PAH on pregnancy outcomes, and to report the multidisciplinary perioperative
management strategy from the largest comprehensive cardiac hospital in China.
Design: Observational case series study.
Setting: Tertiary referral acute care hospital in Beijing, China.
Participants: The cases of 17 consecutive pregnant idiopathic PAH patients undergoing abortion or parturition at Anzhen Hospital were
Interventions: Preoperative characteristics, anesthesia method, intensive care management, PAH-specific therapy, and maternal and neonatal
outcomes were analyzed in this case series study.
Measures and Main Results: Maternal and neonatal outcomes were the main measures. The mean ages of the 17 parturient women with
idiopathic PAH were 28.3 7 5.4 years, and the mean systolic pulmonary arterial pressure was 97.9 7 18.6 mmHg. Fifteen patients (88.2%)
received PAH-specific therapy before delivery, including sildenafil, iloprost, and treprostinil. All except 1 parturient received epidural anesthesia
for surgery due to an emergency Caesarean section. Three patients experienced pulmonary hypertension crisis that necessitated conversion to
general anesthesia. Ten parturients underwent Caesarean delivery at a median gestational age of 31 weeks. Three patients developed acute
pulmonary hypertensive crisis intraoperatively. Two patients underwent cardiopulmonary resuscitation and extracorporeal membrane
oxygenation support. The maternal mortality was 17.6% (3/17). Of the 10 delivered neonates, 9 (90.0%) survived.
Conclusions: The maternal mortality of the idiopathic PAH parturient was high in this case series from China. The authors applied epidural
anesthesia, early management with multidisciplinary approaches, PAH-specific therapy, avoidance of oxytocin, and timely delivery or pregnancy
termination to improve maternal and neonatal outcomes.
Key Words: idiopathic pulmonary arterial hypertension; outcome; pregnancy