妊娠高血压综合征232例监测与治疗

Monitoring and therapy in 232 patients with pregnancy-induced hypertension syndrome

目的检测妊娠高血压综合征患者血管紧张素Ⅱ(angiotonim Ⅱ AngⅡ)、醛固酮、内皮素,无创性心血管血流参数检测仪(TP-CBS)作血流动力学参数测定,探讨不同类型妊娠高血压综合征的血流动力学改变和相应治疗方案。方法:对比妊娠高血压综合征232例与正常孕晚期妇女200例临床资料。结果在妊娠高血压综合征患者可表现为AngⅡ增高、醛固酮增高或AngⅡ和醛固酮正常;高AngⅡ妊娠高血压综合征常有血液浓缩和低血容量,表现为低心排血量和高血管阻力,可采用解痉、扩容治疗;而高醛固酮妊娠高血压综合征呈低血黏度,常伴有血容量增加,心排血量增加,可采用解痉和适当利尿治疗,而不宜采用扩容治疗。结论检测AngⅡ、醛固酮、内皮素以及血液流变学及血流动力学指标,对妊娠高血压综合征进行分组,采用针对性治疗可收到较好的疗效。

Objectives and Methods To simultaneously detect hemorheology, serum levels of angiotensin Ⅱ （A Ⅱ ）, aldosterone （ALD） and endothelin （ET） in 232 patients with pregnancy-induced hypertension syndrome （PHS）, and in 200 women with normal late period of pregnant as control. The data were analyzed. Results There were three different conditions： （1） patients with high level A Ⅱ ; （2） some with high level ALD; （3） both A Ⅱ and ALD levels were normal. Using non-invasive method to detect blood flow indices, we found that different types of PHS had different haemodynamic changes. PHS could be classified and treated according to these monitoring indices. Patients with high level AlI often accompanied with pachemia, hypovolemia, low cardiac output and high peripheral resistance, and could be treated by spasmolysis and expanded volume. High level ALD type, often accompanied with low blood viscosity and increase of blood volume and cardiac output, could be treated by spasmolysis and moderate diuretics, but expanded volume therapy was not suitable. Conclusions The better effectiveness could be shown if different treatment are used for different types of PHS, which are classified according to hemorhealogy, levels of A Ⅱ , ALD and ET.