[Perioperative outcomes and anesthetic management of pregnancy termination in patients with pulmonary hypertension].

摘要

OBJECTIVES: To investigate outcomes of pregnancy termination in women with pulmonary hypertension (PH) and the correlations of anesthetic management strategies and intraoperative blood pressure variability with postoperative adverse events. METHODS: Sixty-two women underwent termination of pregnancy complicated by PH from June, 2019 to December, 2024 in Guangdong Provincial People's Hospital, including 24 women with mild-to-moderate PH and 38 with severe PH. Perioperative parameters and clinical outcomes of the patients were compared between the two groups. RESULTS: The most common subtype of PH in these women was pulmonary arterial hypertension (82.3%), caused primarily by congenital heart diseases (most frequently atrial or ventricular septal defects). The majority of the women underwent pregnancy termination by dilation and curettage (P=0.02) under general anesthesia (P=0.002). A total of 5 postoperative adverse events were recorded, including PH crisis (3 cases), arrhythmia requiring intervention (1 case), and pulmonary embolism (1 case). After multivariate adjustment, the severity of PH was significantly correlated with both postoperative ICU admission and prolonged postoperative length of stay (P<0.05). Among the patients undergoing dilation and curettage, the incidence of postoperative adverse events was significantly higher in patients receiving intrathecal anesthesia (P=0.014). A high blood pressure variability during surgery was correlated with a high rate of postoperative adverse events (P<0.05), which was significantly lower in patients with a blood pressure variability below the third tertile (OR=10.25, 95% CI=1.06-98.84, P=0.034). CONCLUSIONS: Postoperative recovery following pregnancy termination is associated with the severity of PH. Anesthetic methods for pregnancy termination should be individualized. Patients with a high intraoperative blood pressure variability have an increased risk of postoperative adverse events, and inhaled nitric oxide therapy is effective for reducing pulmonary arterial pressure during surgery. 目的: 分析妊娠合并肺动脉高压患者终止妊娠的结局，重点探讨不同麻醉管理策略和术中血压变异性与术后不良事件的相关性。方法: 选取广东省人民医院于2019年6月至2024年12月收治的62例妊娠合并肺动脉高压行终止妊娠的患者，根据肺动脉高压严重程度分为轻中度组（24例）和重度组（38例），收集并回顾性分析两组患者的围术期资料及术后结局。结果: 妊娠合并肺动脉高压最常见的分型为动脉性肺动脉高压（82.3%），主要病因是先天性心脏病，其中房间隔缺损或室间隔缺损最为常见。患者更多在全身麻醉下（P=0.002）经刮宫术（P=0.02）终止妊娠。总体发生5例术后不良事件（8.1%），其中3例肺高压危象、1例需干预的心律失常、1例肺栓塞。经多变量校正后，肺动脉高压的严重程度与术后转入ICU及术后住院时间延长存在显著关联性（P<0.05）。在行刮宫术的患者中，椎管内麻醉组术后不良事件发生率更高（P=0.014）。术中血压波动较大与术后不良事件发生率更高相关（P<0.05），且术中血压波动在变异系数上三分位阈值以下的患者，表现为更低的术后不良事件发生率（OR=10.25，95% CI=1.06-98.84，P=0.034）。结论: 妊娠合并肺动脉高压患者的终止妊娠术后恢复进程与肺动脉高压程度相关。终止妊娠的麻醉方式选择应遵循个体化的麻醉管理策略。术中血压变异性高与术后不良事件风险增加有关。一氧化氮吸入疗法是术中降低肺动脉压力的重要治疗方式。.