妊娠期高血压疾病患者产后血压恢复的影响因素分析

Analysis on the factors for recovery of postpartum blood pressure in patients with hypertension during pregnancy

目的:研究妊娠期高血压疾病患者产后血压变化并分析其相关影响因素。方法:回顾性分析130例妊娠期高血压疾病患者(不包括慢性高血压及慢性高血压合并子痫前期患者)的临床资料,包括患者一般信息、体质指数(BMI)、孕期体重增长情况、妊娠期高血压发病时间及分娩孕周、分娩方式,并记录患者产后血压恢复到正常水平的时间,对其影响因素进行单因素分析和多因素Logistic回归分析。结果:130例患者血压恢复正常的时间是产后(24.1±22.8)d,其中57例产后3 d血压恢复正常,93例产后6周恢复正常,120例产后12周恢复正常。产后3 d血压恢复组妊娠期收缩压、舒张压显著低于产后3 d血压未恢复组(P<0.05),且分娩孕周显著大于未恢复组(P<0.05);收缩压、舒张压、分娩孕周是产后3 d血压未恢复的独立影响因素。产后6周血压恢复组血清白蛋白水平显著低于产后6周血压未恢复组(P<0.05),且分娩孕周显著大于未恢复组(P<0.05);血清白蛋白水平为产后6周血压未恢复的独立危险因素。产后12周血压恢复组高血压家族史构成比、血清白蛋白水平显著低于未恢复组(P<0.05);血清白蛋白是产后12周血压未恢复的独立影响因素。结论:大部分妊娠期高血压疾病患者在产后12周内可恢复正常血压。妊娠期高血压疾病严重程度、高血压家族史、血清白蛋白水平、分娩孕周是影响产后血压恢复正常时间的高危因素。

Objective:To study the changes of postpartum blood pressure and analyze the related factors in patients with hypertension during pregnancy(HDP).Methods:The clinical data of 130 pregnant women with HDP(not including chronic hypertension and chronic hypertension complicated by preeclampsia)were retrospectively analyzed,such as general information of the patient,body mass index(BMI),body weight gain,the time of hypertension onset,the time of pregnancy and delivery mode,and the time when the patient’s post-natal blood pressure was restored to the normal level.These factors were analyzed with one-way analysis of variance and multifactor logistic regression analysis.Results:The time blood pressure returned to normal levels was(24.1±22.8)days in 130 pregnant women with HDP.Among them,57 patients’blood pressure returned to normal within 3 days postpartum,93 patients returned to normal within 6 weeks postpartum,and 120 patients returned to normal within 12 weeks postpartum.Systolic blood pressure and diastolic blood pressure during pregnancy in the blood pressure recovery group at 3 days postpartum were significantly lower than those in the non-recovery group(P<0.05),and gestational week at delivery was significantly more than that in the non-recovery group(P<0.05).Moreover,systolic blood pressure,diastolic blood pressure and gestational week at delivery were independent influencing factors for the non-recovery of postpartum blood pressure at day 3 postpartum.The serum albumin level in the blood pressure recovery group was significantly lower than that in the blood pressure non-recovery group at week 6 postpartum(P<0.05),and the gestational week of delivery was significantly more than that in the blood pressure non-recovery group at the 6th week postpartum(P<0.05).Serum albumin was an independent risk factor for blood pressure recovery at 6th week postpartum.The proportion of family history of hypertension and serum albumin in the blood pressure recovery group after 12 weeks postpartum were significantly lower than those in the non-recovery group(P<0.05),and serum albumin was an independent factor affecting the blood pressure that did not recover after 12 weeks postpartum.Conclusions:Most patients with HDP can recover blood pressure to normal level within 12 weeks after delivery.Severity of gestational hypertension,family history of high blood pressure,serum albumin level and gestational age are the high risk factors influencing the time postpartum blood pressure return to normal.