利托君对孕妇心脏储备功能影响的临床监测分析

Changes of Cardiac Reserve Function of Pregnant Woman during the Use of Ritodrine

目的:探讨利托君抑制宫缩时对孕妇心脏储备功能的影响。方法:2010年3～9月收治入重庆医科大学附属第一医院的符合先兆早产诊断的孕妇51例(用药组)与正常孕妇50例(对照组)作为研究对象。采用心音信号处理技术检测两组孕妇心脏储备功能各项指标,包括心率、第一心音幅值与第二心音幅值(S1/S2)比值、舒张期时限与收缩期时限(D/S)比值。用药组孕妇在用药前以及用药后5分钟、0.5小时、1小时、4小时、24小时各测量1次以上指标,然后隔日测量1次直到停止用药,数据取其均值。对照组只测量1次。比较用药前后及正常孕妇的血压和心脏储备功能指标的变化与用药时间的关系。结果:①用药组用药后孕妇的舒张压显著低于用药前和对照组,差异有统计学意义(P<0.05);用药组用药后孕妇的心率和S1/S2比值均显著高于用药前和对照组,D/S比值显著低于用药前和对照组,差异均有高度统计学意义(P<0.01)。②利托君使用过程中孕妇的心率与S1/S2比值呈正相关(r=0.466,P<0.05),与D/S比值呈负相关(r=-0.680,P<0.01),当孕妇心率>120/min时,D/S比值≤1.0的发生率为74.51%,孕妇心率≥140/min者有4例,D/S比值均≤0.8。③用药组用药24小时使用过程中孕妇心率的增加值随用药时间逐渐增大,并于用药后4小时达到最高值,用药后24小时心率增加值基本稳定。结论:利托君应用过程中随着孕妇心率的增加,心脏储备功能下降,应给予严密监测,以防发生妊娠不良结局。

Objective：To investigate changes of cardiac reserve function of patients receiving ritodrine to- colysis. Methods：Gravid patients between 23 and 33 gestation weeks were admitted from march to Septem- ber 2010 in The first affiliated hospital of Chongqing Medical University for preterm labor were involved in this study, one hundred and one pregnant women were included in our study. The study and control groups were composed of patients with preterm labor （study group, n = 51 ） and patients with uneventful pregnancies （control group, n = 50 ）, 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. While the patients in study group were evaluated before and during treatment （5 minutes, 30 minutes,lhours,2 hours,4 hours and 24 hours after initiation of ritodrine infusion）,those in control group were evaluated only once. Results：By the 24 hours of treatment,the diastolic blood pressures of the preg- nant women was significantly lower than before treatment and the control group（ P 〈 0.05） ;the heart rates and the ratio of S1/S2 of the pregnant women was significantly higher than before treatment and the control group （P〈0.01）, The ratio of D/S during treatment was significantly lower than before treatment and thecontrol group（ P〈0.01 ）. The maternal heart rates and S1/S2 were positively correlated in the study group（ r = 0.466, P〈0.05 ）, maternal heart rates and D/S were negatively correlated （ r = -0.68, P〈 0.01 ） , When maternal heart rates 120bpm,the incidence rate of D/S ≤ 1 was 74. 51%, 4 pregnant women whose heart rates ≥140bpm,all of them D/S≤0.8. The change from baseline in maternal heart rates was increased with the extension of treatment time, The highest peak of the change always occurred at the 4 hours after initiation of ritodrine infusion and basically stable by 24 hours. Conclusions.The cardiac re- serve function of pregnant woman during treatment of ritodrine hydrochloride decreased along with the in- crease of maternal heart rates.