子痫前期孕妇血流动力学变化临床分析

Clinical Analysis of Hemodynamic Changes in Preeclampsia Pregnant Women

目的:用无创血流动力学监测系统研究子痫前期孕妇的血流动力学变化。方法:选择单胎妊娠孕妇418例,分为妊娠期高血压无并发症组、子痫前期无并发症组、子痫前期有并发症组和正常妊娠组。采用无创血流动力学监测系统检测4组孕妇的血流动力学指标。结果:子痫前期两组孕妇的心率(HR)略低,但4组间的HR比较,差异无统计学意义(P>0.05)。正常妊娠组比另3组孕妇平均动脉压(MAP)和外周阻力(SVRI、SVR)明显降低,心脏收缩功能(ACI、VI)明显升高(P<0.05)。子痫前期两组孕妇比正常妊娠组和妊娠期高血压组孕妇的胸液水平(TFC)明显升高(P<0.05)。妊娠期高血压组、子痫前期无并发症组与正常妊娠组3组孕妇的心排出量(CI、CO、SI、SV)比较,差异无统计学意义(P>0.05)。子痫前期有并发症组与子痫前期无并发症组相比,MAP及外周阻力(SVRI、SVR)明显升高(P<0.05),心排出量及心脏收缩功能(CI、CO、SI、SV、ACI、VI)明显降低(P<0.05)。结论:子痫前期时,孕妇的心排出量及心脏收缩功能的降低及外周阻力的明显增高可能是引起妊娠并发症的重要因素,无创血流动力学监测系统可用于指导妊娠期高血压疾病患者的治疗。

Objective： To investigate the hemodynamic changes in preeclapmpsia pregnant women by noninvasive hemodynamic monitoring system. Methods：418 singleton pregnant women were selected and classified into following groups： uncomplicated gestational hypertension （GH）（ n = 159 ）, uncomplicated preeclampsia （ PE ） （ n = 123 ）, complicated preeclampsia （ n = 74 ）, and normal pregnancy （ NP ） （ n = 62 ）. Noninvasive hemodynamic monitoring was performed for all patients. Results： Heart rate （HR ） in two PE group was lower, but there was no statistic difference among the four groups（ P〉0. 05）. The mean arterial pressure （ MAP）, systemic vascular resistance （SVR） and systemic vascular resistance index （ SVRI ） were significantly lower in NP group than the other three groups, but the cardiac systolic function （acceleration index ACI, velocity index VI） was obviously higher（ P 〈 0.05） . Compared to GH group and NP group, the thoracic fluid content （TFC） was higher in the PE group（ P 〈 0.05 ）. There were no statistically significant differences in cardiac output （cardiac index CI, cardiac output CO, stroke volume index SI, stroke volume SV） among the GH group, uncomplicated PE group and NP group （ P 〉 0.05 ）. MAP and peripheral resistance （SVRI, SVR was significantly higher and cardiac output and cardiac systolic function （CI, CO, SI, SV, ACI, VI was markedly lower in the PE complicated group than the uncomplicated group（ P 〈0.05 ）. Conclusions：Pregnancy complication is associated with reduced maternal cardiac systolic function and cardiac output and increased peripheral resistance in preeclampsia. Noninvasive hemodynamic monitoring can guide the treatment of hypertensive disorders of pregnancy.