孕晚期孕妇心音图检测心力储备的价值研究

Study on the Value of Using the PCGT to Test the Cardiac Contractility Reserve in the Third Trimester of Pregnancy

目的:探讨孕晚期孕妇心音图试验(PCGT)检测心力储备(CCR)的价值。方法:选择孕28~41+6周481例正常孕妇,32例心血管疾病孕妇以及100例正常产妇纳入本研究。根据孕周分为28~31+6周、32~34+6周、35~41+6周和产后4个组。PCGT测量、分析孕产妇HR、S1/S2和D/S的变化趋势以及各指标之间的关系,根据正常孕妇的CCR指标测试数据得出正常孕妇孕晚期不同孕周各指标的95%参考值范围,分析心血管疾病孕妇的CCR指标异常情况。结果:不同孕周正常孕妇之间HR、S1/S2、D/S比较,差异均无统计学意义(P>0.05);不同孕周正常孕妇与产后妇女相比,HR增快,S1/S2增大,D/S降低,差异均有统计学意义(P<0.05);正常孕妇HR和S1/S2呈正相关(r=0.295,P=0.000);HR和D/S呈负相关(r=-0.393,P=0.000);S1/S2和D/S呈负相关(r=-0.406,P=0.000)。以PCGT测量CCR指标的正常孕妇孕晚期不同孕周各指标的95%参考值范围为正常标准,心血管疾病孕妇HR的异常率28.6%~45.5%,S1/S2和D/S的异常率63.6%~85.7%,CCR完全正常者6例(18.75%),心功能均为Ⅰ级(100%,6/6),CCR指标异常患者26例(81.25%),心功能Ⅰ级3例(11.5%,3/26)。结论:PCGT检测CCR作为一种无创、低廉、简单的孕晚期心脏病筛查方法具有一定价值,孕晚期孕妇PCGT检测HR、S1/S2、D/S超过参考值范围者,需考虑孕妇可能存在心血管疾病或患病隐患,但对于心功能Ⅰ级的心血管疾病孕妇,PCGT检测可能出现漏诊的情况。

Objective：To study the value of using the PCGT to test the cardiac contractility reserve in the third trimester of pregnancy. Methods ：The heart rate,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 481 normal gravidas,32 pregnant women with cardiovascular disease and 100 normal postpartum women were measured and analyzed. The normal pregnant women were classified into three groups ：28 -31^6/7 weeks,32 -34^6/7 weeks,35 -41^6/7 weeks. Results： According to the CCR data,a normal reference range of CCR of normal pregnant women during the third trimesters was primarily gotten. The normal maternal HR and S1/S2 at 32 -34^6/7 gestational weeks were higher,while the D/S was lower than those at 28 -31^6/7 and 35 -41^6/7 weeks, but there were not significantly differences between them. However, in postpartum women, the HR and S1/S2 were significantly lower while the D/S was significantly higher than that of pregnant women at any gestational weeks（ P 〈0.05）. In addition,the normal pregnant women HR was positively correlated with the S1/S2 （r=0. 295, P = 0. 000） and negatively correlated with the D/S （ r = - 0. 393, P = 0. 000） ; the S1/S2 were negatively correlated with the D/S （ r = - 0.406, P = 0.000 ）. Abnormal rate of HR in cardiovascular disease pregnant women were 28.6% -45.5% ,the abnormal rate of S1/S2 and D/S was 63.6% - 85.7%. CCR was normal in 6 cases （ 18.75% ）, and the cardiac function was grade I （6/6,100%）. There were 26 patients with abnormal CCR index（81.25% ） ,and cardiac function grade I（ 11.5%, 3/267. Conclusions：As a noninvasive,inexpensive and simple method, PCGT detection of CCR has certain value for the screening of late pregnancy heart disease. PCGT detection of HR, S1/S2, D/S in late pregnancy women above the reference value range need to consider the possibility of cardiovascular disease or disease risk, but for cardiac function grade I patients with cardiovascular disease, PCGT detection may be missed.