胎儿生长受限与小于胎龄孕妇心输出量和全身血管阻力的差异研究

Study on differences of cardiac output and systemic vascular resistance between fetal growth restriction and small for gestational age in pregnant women

目的比较妊娠合并胎儿生长受限(fetal growth restriction,FGR)和妊娠合并小于胎龄(small for gestational age,SGA)孕妇心输出量(cardiac output,CO)和全身血管阻力(Systemic vascular resistance,SVR)的差异。方法选择2016年5月-2019年7月在中国人民解放军联勤保障部队第901医院孕检和分娩的孕妇,102例诊断为FGR的孕妇(FGR组),64例诊断为单纯SGA的孕妇(SGA组),401正常孕妇(对照组),均为孕28周以上,进行血流动力学进行评估,比较3组产妇的CO和SVR的组间差异,并分析这些指标与新生儿出生体质量的相关性。结果FGR组的心率(heart rate,HR)和CO低于SGA组,而平均动脉压(mean arterial pressure,MAP)、SVR和子宫动脉搏动指数高于SGA组,差异均具有统计学意义(P<0.05)。与正常组比较,SGA组CO和SVR差异无统计学意义(P>0.05)。新生儿出生体质量百分位数与CO呈正相关,与SVR和子宫动脉搏动指数呈负相关(P<0.05)。结论合并FGR的孕妇,其母体血流动力学特征表现为SVR增加,CO减少。单纯SGA胎儿产妇具有基本正常的CO和SVR。

Objective To compare the differences of cardiac output(CO)and systemic vascular resistance(SVR)between pregnant women with fetal growth restriction(FGR)and those with small for gestational age(SGA).Methods From May 2016 to July 2019,102 pregnant women diagnosed as FGR(FGR group),64 as SGA alone(SGA group)and 401 as normal control group were evaluated on hemodynamics.The differences of CO and SVR between the three groups were compared,and the correlation between these parameters and neonatal birth weight was investigated.Results The heart rate(HR)and CO of the FGR group were lower than that of the SGA group,while the mean arterial pressure(MAP),SVR and uterine arterial pulse index were higher than that of the SGA group,with statistically significant differences(P<0.05).Compared with the normal group,the difference between CO and SVR in the SGA group was not statistically significant(P>0.05).The percentile of newborn birth mass was positively correlated with CO,and negatively correlated with SVR and uterine artery pulse index(P<0.05).Conclusion The maternal hemodynamic characteristics of pregnant women with FGR were increased SVR and decreased CO.Single SGA fetuses have normal CO and SVR.