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中文摘要：
目的分析重度肺动脉高压（PAH）产妇剖宫产围手术期发生肺动脉高压危象（PHC）的术前危险因素，探讨其临床价值。方法采用回顾性分析方法，选择2008年1月1日至2016年12月31日在北京安贞医院接受剖宫产手术的152例重度PAH产妇作为研究对象，按照围手术期是否发生PHC分为两组。通过病例管理系统提取患者年龄、身高、体重、孕周、孕次、PAH类型、急诊手术、纽约心脏病协会（NYHA）心功能分级，术前超声左室射血分数（LVEF）、左室舒张期末内径（LVEDD）、超声TI法估测肺动脉收缩压（sPAP）、桡动脉收缩压（SBP）和舒张压（DBP）、心率、未吸氧时脉搏血氧饱和度（SpO2），术前是否口服西地那非、是否放置漂浮导管、是否应用去甲肾上腺素，以及围手术期PHC发生情况和术后结局。对可能的术前危险因素进行两组间单因素比较和多因素logistic回归分析；绘制受试者工作特征曲线（ROC），分析各危险因素对PHC的诊断价值。结果152例患者中排除10例全麻下同期行心脏手术患者、4例全麻下行剖宫产术患者，最终共138例纳入分析；围手术期发生PHC27例（19．57％），死亡17例（病死率62．96％）。与非PHC组比较，PHC组患者年龄更小（岁：25．07±3．55比27．64±4．82），心功能更差[NYHA（级）：3．22±0．64比2．85±0．53]，术前LVEDD更小（mm：38．78±4．76比43．91±9．67），未吸氧时SpO2（0．83±0．12比0．92±0．06）及口服西地那非患者比例更低（29．63％比56．76％），术前SPAP[mmHg（1mmHg=0．133kPa）：113．41±24．73比99．35±21．10J、DBP（mmHg：79．63±13．23比75．23±12．14）及放置漂浮导管（85．19％比57．66％）、艾森曼格综合征（70．37％比37．84％）、急诊手术患者比例更高（48．15％比23．42％，均P≤0．1）。将单因素分析差异有统计学意义（取P≤0．1）的变量进行多
英文摘要：
Objective To analyze preoperative risk factors of perioperative pulmonary hypertension crisis （PHC） for pregnant woman with severe pulmonary artery hypertension （PAH）, and approach its clinical value. Methods A retrospective analysis was conducted. The clinical data from 152 pregnant women with severe PAH underwent cesarean delivery admitted to Beijing Anzhen Hospital from January 1st 2008 to December 31st 2016 was collected. The patients were divided into two groups according to with perioperative PHC or not. Through the case management system, age, height, weight, gestational age, pregnancy time, type of PAH, emergency or selective surgery, New York Heart Association （NYHA） cardiac function classification, and preoperative ultrasound left ventricular ejection fraction （LVEF）, left ventricular diastolic final diameter （LVEDD）, the pulmonary artery systolic pressure （sPAP） estimated by ultrasonic TI method, radial artery systolic blood pressure （SBP） and diastolic blood pressure （DBP）, heart rate （HR）, pulse oxygen saturation （SpO2） without oxygen, oral sildenafil ingestion, having Swan-Ganz catheter placement or not, and whether used norepinephrine or not, as well as the occurrence of perioperative PHC and clinical outcomes were collected. Possible preoperative risk factors were compared between the two groups by single factor and muhiple factors logistic regression analysis. The receiver-operating characteristic curve （ROC） was plotted to assess the diagnostic value of various risk factors. Results A total of 152 patients were screened. Ten patients got heart surgery under general anesthesia at the same time, and 4 patients experiencing cesarean section with general anesthesia were excluded. 138 patients were enrolled finally, 27 patients underwent perioperative PHC （19.57%）, and 17 patients died with a mortality of 62.96%. Compared with non-PHC group, the patients in PHC group were older （years： 25.07 ± 3.55 vs. 27.64 ± 4.82）, had a poor cardiac function
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