分娩前后腹腔内压的测定

Determination of intra-abdominal pressure before and after delivery

目的比较妊娠正常妇女在分娩前后的腹腔内压与血流动力学的变化差异。方法纳入2011年11月-2012年3月拟在广州医学院第三附属医院进行分娩的妊娠妇女24例进行研究,根据妊娠类别分为单胎妊娠组（20例）及双胎妊娠组（4例）,于分娩前后使用膀胱内压方法监测其腹腔内压变化,并观察血压、腹腔灌注压及心率的变化。结果 （1）单胎妊娠妇女分娩后的收缩压及舒张压依次为（118.05±10.12）mm Hg、（70.95±7.65）mm Hg,与分娩前比较无统计学意义（P〉0.05）;分娩后产妇的心率为（83.76±11.31）次/min,较分娩前的（95.29±14.11）次/min有显著下降,且分娩后腹腔灌注压较分娩前也有明显提升,前后比较差异有统计学意义（P〈0.01）;（2）分娩前单胎妊娠妇女的IAP波动范围为14.28-48.96mm Hg,平均（35.13±8.81）mm Hg,腹内高压（IAP高于12mm Hg）率100%,分娩后IAP范围则为8.84-25.84mm Hg,平均（16.16±4.61mm Hg）,腹内高压率为85.7%（18/21）,分娩前后对比差异有统计学意义（P〈0.01）。（3）双胎妊娠妇女分娩前IAP为（38.25±10.18）mm Hg,均属于腹内高压;分娩后IAP则为（22.61±10.98）mm Hg,其中腹内高压者占75%（3/4）;分娩后IAP较分娩前下降明显（P〈0.01）。结论正常妇女妊娠晚期的IAP明显增高,分娩后IAP明显下降而腹腔灌注压明显增高,血流动力学保持不变。临床上需加大研究力度,以便更为准确地确定孕产妇的正常IAP范围,为高危IAH和ACS的有效防治提供参考依据。

Objective To compare the changes of intra-abdominal pressure（IAP） and hemodynamic differences before and after delivery in the normal pregnant women. Methods 24 pregnant women,who were going to deliver in the Third Affiliated Hospital of Guangzhou Medical College from November 2011 to March 2012,were divided into a single pregnancy group（20 cases） and a twin pregnancy group（4 cases） according to the pregnant categories.Then the changes of intra-abdominal pressure before and after delivery were monitored by intravesical pressure measurement,in additional,the changes of blood pressure,abdominal perfusion pressure and heart rate were observed. Results（1）In the single pregnancy group,the systolic blood pressure and diastolic blood pressure of the pregnant women after delivery were（118.05±10.12）mm Hg and（70.95±7.65）mm Hg respectively,with no significant differences from those before delivery（P〈0.05）;While maternal heart rate after the delivery was（83.76±11.31）/min,which was significantly decreased compared with that before delivery of（95.29±14.11）/min,and abdominal perfusion pressure increased significantly than that before delivery,and the differences were significant（P〈0.01）.（2）The IAP range of women with singleton pregnancy was from 14.28 to 48.96 mm Hg with an average of（35.13±8.81）mm Hg before delivery, so the incidence of intra-abdominal hypertension（IAP high 12 mm Hg） was 100%;While IAP range after delivery was from 8.84 to 25.84 mm Hg with an average of（16.16±4.61）mm Hg,so the incidence of intra-abdominal hypertension was 85.7%（18/21）,there was a significant difference before and after childbirth（P〈0.01）.（3）The IAP of women with twin pregnancy before delivery was（38.25±10.18）mm Hg,which was in the range of intraabdominal hypertension;While that after delivery was（22.61±10.98）mm Hg,only 75%（3/4）of those were diagnosed intra-abdominal hypertension. In short,IAP decreased significantly after delivery（P〈0.01）. Conclusion The IAP of normal women increased significantly during late pregnancy,with a significant descent of IAP and an elevation of abdominal perfusion pressure after childbirth and without any hemodynamic changes.It＇s time to strengthen the research about that in clinic,in order to determine the normal range of IAP in pregnant women more accurately,and to provide reference for effective prevention and treatment of high-risk IAH and abdominal compartment syndrome.