正常妊娠及妊高征患者血液动力学参数测定及其临床意义

Blood Dynamics Parameters of Normotensive and PIH Women

目的 探讨正常妊娠孕妇血液动力学变化规律及妊高征患者血液动力学的变化特点。 方法 应用无创伤心血管参数测量仪 (TP- CBS)对 896例妊娠妇女分别在妊娠早、中、晚期及产后序贯测定血液动力学有关参数 ,其中资料完整的正常妊娠 30 0例 (正常妊娠组 ) ,妊高征 97例 (妊高征组 ) ,并与 80例非孕妇女 (对照组 )进行对照研究。 结果 正常妊娠组在妊娠早期平均动脉压 (MAP)、心输出量 (CO)、心脏指数 (CI)、心搏量 (SV)、心搏指数 (SI)、及血管顺应性 (AC)均高于对照组 ,外周阻力 (TPR)和血粘度 (V)低于对照组 ,但均无统计学意义。妊娠中期 ,CO5 .0 5 L/ min,SI39.74ml/搏 .m2 ,明显高于对照组 (P<0 .0 5 )。TPR 1.0 2 PRU ,明显低于对照组 (P<0 .0 5 )。妊娠晚期 (2 8～ 32周 ) ,血液动力学各参数均发生更明显变化 :CO 5 .5 6 L / m in,SI 42 .49m l/搏 .m2 ,TPR 0 .96 PRU ,AC1.83m l/ mm Hg(P<0 .0 1) ,并持续到妊娠晚期 (>36周 )。产后 1周 ,CO、SV、SI、AC仍与对照组有显著差异 (P<0 .0 5 )。妊高征患者在妊娠早期各参数与正常妊娠组无显著差异。妊娠中期 ,MAP 90 .2 2mm Hg,TPR 1.2 3PRU,V 4.39CP,明显高于正常妊娠组 (P<0 .0 5 )。妊娠晚期 ,CO 5 .2 2 L / m in,SI 38.6 4m l/搏 .m2 ,AC 1.

Objective To study the changing patterns of blood dynamics parameters in normotensive pregnancy and pregnancy induced hypertension(PIH). Methods In comparison with 80 non pregnant women(control group), blood dynamics parameters of 896 pregnant women were measured by non invasive cardiovascular parameters surveyor (TP CBS) in each trimester, in which accurate data were got from 300 normotensive women(normotensive group) and 97 PIH women(PIH group). Result Average arterial pressure(MAP), cardiac output(CO), cardiac index(CI), stroke volume(SV), stroke index(SI) and argio compliance(AC) of the normotensive group were all higher than the control group, while peripheral resistance(TPR) and blood viscosity(V) were lower than the control group in the tirst trimester. But no statistical significance was shown. In the second trimester, CO (5.05L/min) and SI (39.74ml/pulse·m 2) were significantly higher than the control group, while TPR (1.02PRU) was significantly lower than the control group( P <0.05). In the early third trimester I(28 th ~32 th week), all parameters changed more notabaly: CO, 5.56 L/min, SI, 42.49 ml/pulse·m 2,TPR, 0.96 PRU,AC, 1.83 ml/mmHg( P <0.01). This was still existing till the advanced stage II(after the 36 th week). CO, SV, SI and AC of the normotensive group were still obviously different with the control group( P <0.05) week after delivery.No significant difference was shown in all parameters of PIH women and the normotensive group in the first trimester. In the second trimester, MAP, 90.22 mmHg, TPR, 1.23 PRU and V, 4.39 CP of PIH women were much higher than the normotensivegroup. In the early third trimester I, CO (5.22L/min). SI(38.64 ml/pulse·m 2) and AC (1.29ml/mmHg) decreased notably ( P <0.05) and MAP, TPR and V of PIH women were much higher than the normotensive group( P <0.01). This was still existing till the late trimester and one week after delivery. MAP, TPR and V of mild PIH women were much higher than the normotensive group. MAP, TPR and V of PIH women increased notabaly( P <0.01), while CO, CI, SV, SI and AC decreased notabaly( P<0.01, P<0.05 ) when the conditon of PIH became severe. Conclusion Monitoring the change of blood dynamics parameters of pregnant women can provide a new method for prevention, detection and cure of PIH in early stage.