子痫前期孕妇心脏储备功能变化与妊娠结局

Clinical analysis of cardiac reserve function and outcome of preeclampsia

目的探讨子痫前期孕妇心脏储备功能的变化与妊娠结局的关系。方法2008年1月至12月，采用随机数字表法选取重庆医科大学附属第一医院产科住院孕妇作为研究对象。其中妊娠期高血压组20例，子痫前期轻度组26例，子痫前期重度组23例，69例正常孕妇分为正常孕妇组1（20例）、正常孕妇组2（26例）、正常孕妇组3（23例），分别与妊娠期高血压组、子痫前期轻度组、子痫前期蕈度组进行配对对照。采用心音信号处理技术监测各组孕妇心脏储备功能指标，包括心率（HR）、第一心音幅值（S1）与第二心音幅值（S2）比值、舒张期时限（D）与收缩期时限（S）比值，并分析其妊娠结局。结果（1）子痫前期重度组孕妇S1／S2比值为4．5±3．2，显著高于妊娠期高血压组的2．2±1．1和正常孕妇组3的2．2±1．1，分别比较，差异均有统计学意义（P〈0．01）。子痫前期重度组孕妇D／S比值为1．1±0．3，显著低于妊娠期高血压组的1．4±0．3和正常孕妇组3的1．4±0．2，分别比较，差异均有统计学意义（P〈0．01）。（2）正常孕妇组1～3的69例孕妇和妊娠期高血压组20例孕妇D／S比值均≥1．00，而子痫前期轻度组26例孕妇中仅1例（1／26，4％）D／S比值〈1．00，子痫前期重度组23例孕妇中4例（4／23，17％）D／S比值〈1．00。（3）子痫前期重度组23例孕妇中有2例因病情较重（S1／S2比值均〉5．00，D／S比值均〈1．00），分娩后在重症监护室治疗（其中1例死于心功能衰竭）；子痫前期轻度组和子痫前期重度组的1分钟新生儿Apgar评分≤7分的分别为4例（4／26，15％）和6例（6／23，26％），转新生儿ICU治疗分别为7例（7／26，27％）和6例（6／23，26％），新生儿死亡分别为2例（2／26，8％）和4例（4／23，17％）。正常孕妇组1—3和妊娠期高血压组的新生儿均正常。结论子痫前期孕妇随病情加重，心脏储备功能下降，其孕妇及新生儿的预后不良。心音信号处理技术对子痫前期孕妇的心脏储备功能检查安全无创、简便有效，值得在临床推广应用。

Objective To investigate cardiac reserve function and pregnant results of preeclampsia. Methods Pregnant women chosen by randomized table and hospitalized in the department of obstetrics of the first affiliated hospital of Chongqing Medical University were involved in this study from January to December,2008. Sixty-nine cases of normal pregnant women were divided into 3 groups： normal group 1 （20 cases）, normal group 2 （26 cases） and normal group 3 （23 cases）. The normal group number 1 to number 3 were paired to gestational hypertension（20 cases）, mild precclampsia（26 cases） and severe preeclampsia （ 23 cases）, respectively. The digital technique of heart sound signal processing was used to measure cardiac reserve function parameters including the heart rate （HR） , the ratio of the amplitude of the first heart sound to the second heart sound （S1/S2） and the ratio of diastolic to systolic duration （D/S） of pregnant women. The pregnant results were also recorded. Results （ 1 ） The ratio of S1/S2 in the group of severe preeclampsia 4.5 ± 3.2 was significantly higher than the group of gestational hypertension 2. 2 ± 1.1 and normal group 3 2. 2 ± 1.1 （ P 〈0. 01 ）. The ratio of D/S of the group of severe preeclampsia 1.1 ±0. 3 was significantly lower than the group of gestational hypertension 1.4 ± 0. 3 and normal group 3 1.4 ± 0. 2 （ P 〈 0. 01 ）. （2） All cases of the normal group number 1 to number 3 and the group of gestational hypertension were found the ratio of D/S ≥ 1.00, whereas 1 case （ 1/26,4% ） of the group of mild preeclampsia and 4 cases（4/23,17% ） of the group of severe preeclampsia were found the ratio of D/S 〈 1.00. （ 3 ） The two cases of the pregnant women （including one woman died of cardiac arrest） with S1/S2 〉5. 00 and D/S 〈 1.00, who were in the group of severe preeelampsia, were sent to Intensive Care Unit after delivery. There were 4 cases（4/26,15% ）and 6 eases（6/23,26% ）of 1 minute Apgar score less than 7, 7 cases（7/26, 27% ）and 6 cases （6/23,26%）sent to neonatal Intensive Care Unit, 2 cases （2/26,8%）and 4 cases （4/23, 17% ）of neonatal death in the group of mild preeelampsia and in the group of severe preeclampsia, respectively. All newborns in the normal group number 1 to number 3 and the group of gestational hypertension were normal. Conclusions The cardiac reserve function of a pregnant woman with preeclampsia is decreased with the severity of preeclampsia and the parturient and neonatal results get worse. The digital technique of heart sound signal processing is a safe, harmless, simple and effective tool to measure cardiac reserve function of preeclampsia, and is worthy of widely used clinically.