重度子痫前期患者血压昼夜节律变化对胎儿血流动力学的影响

Relationship between circadian blood pressure rhythm and fetal hemodynamics in women with severe preeclampsia

目的检测重度子痫前期患者血压为杓型和非杓型昼夜节律对胎儿血流动力学的影响。方法选取住院重度子痫前期患者65例,其中血压昼夜节律为非杓型45例,杓型20例;另选取同期住院分娩的孕妇70例为对照组。(1)动态血压监测所有患者白天与夜间的血压,并根据血压昼夜节律将患者分为杓型和非杓型。(2)彩色超声多普勒测量胎儿脐动脉、腹主动脉、肾动脉、大脑中动脉和母体子宫动脉的S/D、PI、RI值,比较其与血压昼夜节律的相关性。结果 (1)3组夜间舒张压的差异最显著,非杓形组的夜平均舒张压和舒张压昼夜节律均较杓形组显著升高(P<0.05);(2)非杓形组脐动脉S/D、RI较杓形组和对照组均有显著性升高(P<0.05);子宫动脉S/D、RI和大脑中动脉的PI较对照组也有显著性升高(P<0.05);(3)3组脐动脉S/D值与新生儿体重呈正相关(P<0.05)。结论非杓型昼夜节律的血压对胎儿生长发育及围生期结局均有不利影响,降压应以夜间治疗为重点并且足量。

Objective To study the effects of different circadian blood pressure rhythms on fetal circulatory system in women with severe preeclampsia. Methods The study included 65 gravidae with severe preeclampsia（45 and 20 gravidae with non-dipper blood pressure and dipper blood pressure,respectively） and 70 health gravidae as preeclampsia group and control group,respectively.（1） ABPM was used to measure diurnal and nocturnal maternal blood pressure,according to which gravidae were divided into dipper and non-dipper groups.（2） Color doppler ultrasonography was used to assess the systolic to diastolic velocity ratios（S/D）,pulsatility（PI） and resistance indices（RI） of maternal uterine artery,fetal umbilical artery,aorta artery,fetal renal artery and fetal middle cerebral artery. Results（1） The most prominent fluctuation was observed in diastolic pressure of all subjects.Furthermore,nocturnal diastolic pressure and circadian rhythm of diastolic pressure were significantly higher in non-dipper group than those in dipper group（P0.05）.（2） S/D and RI of umbilical artery in were significantly higher than those in dipper and control group,respectively（P0.05）.Meanwhile,S/D and RI of uterine artery,and PI of fetal middle cerebral artery were significantly higher in non-dipper group than those in control group（P0.05）.（3） There was significant positive correlation between S/D of fetal umbilical artery and birth weight in all three groups（P0.05）. Conclusion Non-dipper blood pressure has adverse effects on both fetal growth and perinatal outcome.Furthermore,antihypertensive treatment should be focused on stabilizing the nocturnal blood pressure.