机构：[1]DepartmentofSurgicalIntensiveCareMedicine,BeijingAnzhenHospital,CapitalMedicalUniversity,Beijing Institute ofHeart,LungandBloodVesselDisease,Beijing,China临床科室综合外科监护室(SICU)首都医科大学附属安贞医院[2]DepartmentofAnaesthesia,BeijingAnzhenHospital,CapitalMedicalUniversity,BeijingInstituteofHeart, Lung andBloodVesselDisease,Beijing,China临床科室麻醉中心首都医科大学附属安贞医院[3]DepartmentofAnesthesia,FirstHospitalofTsinghuaUniversity,Beijing,China[4]Department ofObstetricMedicine,BeijingAnzhenHospital,CapitalMedicalUniversity,BeijingInstituteof Heart, LungandBloodVesselDisease,Beijing,China临床科室妇产科首都医科大学附属安贞医院[5]DepartmentofAnesthesiology,JewishHospital,DepartmentofAnesthesiologyandPerioperativeMedicine, University ofLouisville,Louisville,KY
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 reviewed retrospectively. 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 +/- 5.4 years, and the mean systolic pulmonary arterial pressure was 97.9 +/- 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. (C) 2018 Elsevier Inc. All rights reserved.
语种：
外文
被引次数：
WOS：
PubmedID：
中科院(CAS)分区：
出版当年[2017]版：
大类|4 区医学
小类|4 区麻醉学4 区心脏和心血管系统4 区外周血管病4 区呼吸系统
最新[2023]版：
大类|4 区医学
小类|4 区麻醉学4 区心脏和心血管系统4 区外周血管病4 区呼吸系统
JCR分区：
出版当年[2016]版：
Q3PERIPHERAL VASCULAR DISEASEQ3ANESTHESIOLOGYQ3CARDIAC & CARDIOVASCULAR SYSTEMSQ4RESPIRATORY SYSTEM
最新[2023]版：
Q2ANESTHESIOLOGYQ2CARDIAC & CARDIOVASCULAR SYSTEMSQ2PERIPHERAL VASCULAR DISEASEQ2RESPIRATORY SYSTEM
第一作者机构：[1]DepartmentofSurgicalIntensiveCareMedicine,BeijingAnzhenHospital,CapitalMedicalUniversity,Beijing Institute ofHeart,LungandBloodVesselDisease,Beijing,China
共同第一作者：
通讯作者：
通讯机构：[5]DepartmentofAnesthesiology,JewishHospital,DepartmentofAnesthesiologyandPerioperativeMedicine, University ofLouisville,Louisville,KY[*1]DepartmentofAnesthesiology,JewishHospital,DepartmentofAnesthesiologyandPerioperative Medicine, UniversityofLouisville,200AbrahamFlexnerWay,Louisville,KY40202.
推荐引用方式(GB/T 7714)：
Jinglan Zhang ,JiakaiLu,XiaoruiZhou,et al.Perioperative Management of Pregnant Women With Idiopathic Pulmonary Arterial Hypertension: An Observational Case Series Study From China[J].JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA.2018,32(6):2547-2559.doi:10.1053/j.jvca.2018.01.043.
APA：
Jinglan Zhang,,JiakaiLu,XiaoruiZhou,Xuefeng Xu,QingYe...&Jiapeng Huang.(2018).Perioperative Management of Pregnant Women With Idiopathic Pulmonary Arterial Hypertension: An Observational Case Series Study From China.JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA,32,(6)
MLA：
Jinglan Zhang,,et al."Perioperative Management of Pregnant Women With Idiopathic Pulmonary Arterial Hypertension: An Observational Case Series Study From China".JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA 32..6(2018):2547-2559
