妊娠期高血压不同孕期子宫动脉、脐动脉血流动力学参数监测及其母婴结局分析

Hemodynamic parameters monitoring of uterine artery and umbilical artery in pregnancy-induced hypertension with different gestational stages and analysis of maternal and infant outcomes

目的 探讨妊娠期高血压不同孕期患者子宫动脉、脐动脉血流动力学参数的变化及对母婴结局的影响。方法 回顾性分析2017年1月至2020年1月在阳江市中医医院接受产检的70例妊娠期高血压疾病患者的临床资料(观察组),并选择同期于我院接受产检的70例健康孕妇作为对照组。比较两组孕妇的母婴结局,以及孕早期、孕中期、孕晚期时的子宫动脉搏动指数(PI)、阻力指数(RI)、收缩期最大血流速度/舒张末期最大血流速度(S/D)和孕中期、孕晚期脐动脉的PI、RI、S/D。结果 观察组孕妇早产、剖宫产、胎儿窘迫、新生儿窒息发生率及产后出血量分别为15.71%、22.86%、10.00%、11.43%、(588.23±131.56) mL,明显高(多)于对照组的4.29%、10.00%、1.43%、1.43%、(311.85±45.82) mL,新生儿出生体质量为(2.98±0.41) kg,明显低于对照组的(3.47±0.53) kg,差异均有统计学意义(P<0.05);两组孕妇孕早期子宫动脉的PI、RI、S/D比较差异均无统计学意义(P>0.05),但观察组孕妇孕中期、孕晚期时,子宫动脉PI、RI、S/D明显高于对照组,差异均有统计学意义(P<0.05);两组孕妇孕中期脐动脉PI、RI、S/D比较差异均无统计学意义(P>0.05),但观察组孕妇孕晚期时,脐动脉PI、RI、S/D明显高于对照组,差异均有统计学意义(P<0.05)。结论 妊娠期高血压患者子宫动脉、脐动脉血流动力学参数均明显升高,容易影响到胎盘血流灌注,导致不良母婴结局发生,临床上应加强对血流动力学参数的监测。

Objective To investigate the changes of hemodynamic parameters of uterine artery and umbilical artery in patients with pregnancy-induced hypertension at different gestational stages and their effects on maternal and infant outcomes. Methods The clinical data of 70 patients with gestational hypertension who underwent prenatal examination in Yangjiang Hospital of Traditional Chinese Medicine from January 2017 to January 2020 were analyzed retrospectively(the observation group), and the clinical data of 70 healthy pregnant women who received prenatal examination in the hospital during the same period were selected as the control group. The maternal and infant outcomes of the two groups were compared, and the uterine artery pulsatility index(PI), resistance index(RI), systolic maximum flow velocity/end diastolic maximum flow velocity(S/D) at first trimester, second trimester, third trimester, and the umbilical artery PI, RI, S/D at second trimester, third trimester were compared between the two groups. Results The incidence of premature delivery, cesarean section, fetal distress, neonatal asphyxia, and postpartum hemorrhage in the observation group were 15.71%, 22.86%, 10.00%, 11.43%, and(588.23±131.56) mL, which were significantly higher than 4.29%,10.00%, 1.43%, 1.43%, and(311.85±45.82) mL in the control group;the newborn birth weight was(2.98±0.41) kg, which was significantly lower than(3.47±0.53) kg in the control group;the differences were statistically significant(P<0.05).There was no significant difference in PI, RI, and S/D of uterine artery between the two groups at first trimester(P>0.05);the PI, RI and S/D of uterine artery at second trimester, third trimester in the observation group were significantly higher than those in the control group(P<0.05);the PI, RI, and S/D of umbilical artery at second trimester between the two groups showed no statistically significant differences(P>0.05);the PI, RI, and S/D of umbilical artery at third trimester in the observation group were significantly higher than those in the control group(P<0.05). Conclusion The hemodynamic parameters of uterine artery and umbilical artery in pregnancy-induced hypertension are significantly increased, which could easily affect placental perfusion and led to adverse maternal and infant outcomes. In clinical practice, the monitoring of hemodynamics parameters should be strengthened.