子痫前期患者产后血压恢复情况分析

Analysis of recovery of postpartum blood pressure in patients with preeclampsia

目的运用诊室血压(chinic blood pressure,CBP)和动态血压监测(ambulatory blood pressure monitorying,ABPM)探讨子痫前期(preeclampsia,PE)孕妇产后6周左右的血压恢复情况.方法建立前瞻性队列研究,选取在本院分娩且在产后6周左右回院复诊的96例PE产妇和55例正常分娩的产妇作为研究对象,比较两组产妇的一般情况、产后代谢状况及血压水平等.结果PE组CBP和ABPM的收缩压、舒张压各指标均显著高于正常对照组(P<0.05).CBP检测发现PE组患者产后有26例(27.08%)仍患有高血压.ABPM检测发现PE组产后有33例(34.38%)患有白天高血压,43例(44.79)%患有夜间高血压.与正常对照组相比,PE组合并隐匿性高血压的患者显著多于正常对照组[16例(16.67%)vs.2例(3.64%),x2=4.482,P=0.034].PE组血压昼夜节律为非杓型的患者也显著多于正常对照组[47(49.96%)vs.16例(29.09%),P=0.025].结论PE患者产后6周血压并非完全恢复,相对CBP,ABPM可显著提高产后血压患病率及隐匿性高血压、白大衣性高血压及合并异常昼夜血压节律患者的检出率.建议产后应提高对该类患者的动态血压监测.

Objective The study aimed to investigate the blood pressure recovery of pregnant women with preeclampsia(PE)about 6 weeks after delivery by using clinic blood pressure(CBP)and ambulatory blood pressure monitoring(ABPM).Methods A prospective cohort study was established.96 parturients with PE and 55 normal parturients who delivered in our hospital and returned to the hospital about 6 weeks after delivery were selected as subjects.The general condition,postpartum metabolism and blood pressure of the two groups were compared.Results The systolic blood pressure(SBP)and diastolic blood pressure(DBP)of CBP and ABPM in PE group were significantly higher than those in normal control group.CBP monitoring showed that 26 patients(27.08%)in the PE group had sustained hypertension after delivery.ABPM monitoring showed that 33 cases(34.38%)had daytime hypertension and 43 cases(44.79%)had nocturnal hypertension in PE group.Compared with the normal control group,the number of patients with occult hypertension in the PE group was significantly higher than that in the normal control group[16(16.67%)vs.2(3.64%),χ2=4.482,P=0.034].The number of patients with non⁃dipper circadian rhythm of blood pressure in the PE group was also significantly higher than that in the normal control group[47(49.96%)vs.16(29.09%),P=0.025].Conclusions The blood pressure of PE patients did not fully recover at 6 weeks after delivery.Compared with CBP,ABPM can significantly increase the prevalence rate of postpartum blood pressure and the detection rate of masked hypertension,white coat hypertension and patients with abnormal circadian blood pressure rhythm.It is suggested that postpartum PE patients should use ABPM to improve their long⁃term prognosis.