高龄妊娠期高血压患者的动态血压监测

A Clinical Study of Ambulatory Blood Pressure Monitoring in the Advanced Age Patients with Hypertensive Pregnancy

目的研究高龄妊娠期高血压患者动态血压的特点,以及血压对妊娠结局的影响,探讨动态血压监测在高龄妊娠合并高血压疾病中的临床意义.方法回顾性分析2016年1月至2017年8月在昆明医科大学第二附属医院产检并住院分娩的妊娠期高血压患者200例,按照孕妇年龄分为高龄组(年龄≥35岁,n=100)、适龄组(年龄<35岁,n=100).所有孕妇均于妊娠中、晚期行24 h动态血压检查,比较2组动态血压参数的差异、以及与妊娠不良结局的关系.结果高龄组收缩压指标(24 h平均收缩压、白昼平均收缩压、夜间平均收缩压、白昼收缩压负荷值、夜间收缩压负荷值)高于适龄组,差异有统计学意义(P<0.05);高龄组剖宫产、早产儿的发生率高于适龄组,差异有统计学意义(P<0.05);无论高龄组还是适龄组,夜间平均舒张压、白昼收缩压负荷值与胎儿生长受限存在相关性,24 h平均舒张压与早产儿存在相关性.结论动态血压监测对于高龄妊娠期高血压患者,在病情诊断、评估、减少不良妊娠结局等方面有着积极意义,可作为高龄孕妇的产前常规检查.

Objective To study the characteristics of ambulatory blood pressure in advanced age patients with hypertension during pregnancy and its effect on pregnancy outcome, and to explore the clinical significance of ambulatory blood pressure monitoring in advanced age women with hypertension.Methods A retrospective analysis from January 2016 to August 2017, in patients with pregnancy induced hypertension in the Second Affiliated Hospital of Kunming Medical University of production inspection and delivery in hospital as the research object, according to the age of pregnant women, they were divided into the advanced age group（35 years of age or older,n=100）,and age group（age 35,n=100）. All the pregnant women underwent 24-hour ambulatory blood pressure examination in the middle and third trimester of pregnancy to compare the difference of ambulatory blood pressure parameters between the two groups and the relationship between them and the adverse outcome of pregnancy. Results Systolic pressure index of the advanced age group 24 hours average systolic pressure, day mean systolic pressure, night mean systolic pressure, day systolic pressure load value, night systolic pressure load value were higher than the age group, the differences were statistically significant（P〈0.05）; The incidences of cesarean section and premature infant were higher than thase in the age group, and the differences were was statistically significant（P〈0.05）. The average diastolic blood pressure andthe day systolic load were correlated with fetal growth restriction in both the aged and age groups, and the24-hour mean diastolic blood pressure was associated with preterm infants. Conclusions Ambulatory blood pressure monitoring has a positive significance in the diagnosis, evaluation and reduction of adverse pregnancy outcomes in the advanced age patients with hypertensive pregnancy, and can be used as prenatal routine examination for the advanced age pregnant women.