原发性高血压患者孕前心脏功能结构对其妊娠并发症的影响

Influence of pre-pregnancy maternal cardiac function structure on pregnancy complications in patients with essential hypertension

目的:应用超声心动图评估原发性高血压(EH)患者孕前心脏构型与功能,评估妇女孕前血流动力学和左心室特征,探讨妊娠并发症与孕前EH治疗药物之间的关系。方法:根据妇女妊娠期间并发症发病状况将其分为无妊娠并发症组和妊娠并发症组。对比分析两组患者的社会人口学资料、病史及抗EH药物治疗状况、心脏超声参数和血流动力学参数。应用Logisitic回归分析探讨影响EH妇女妊娠并发症发病的相关因素。结果:调查的337例EH患者中,无妊娠并发症患者239例,发生妊娠并发症患者98例,无并发症组的左心室构型正常率(44.77%)显著高于妊娠并发症组(15.31%)。年龄大、体重指数高、产次多、体循环阻力大、左心室向心性重构、左心室舒张功能异常是EH妇女发生妊娠并发症的危险因素(P<0.05);孕前应用钙通道阻滞剂(CCB)、血管紧张素转换酶抑制剂(ACEI)药物是EH妇女发生妊娠并发症的保护因素(P<0.05)。结论:妊娠前出现心脏重构与左心室舒张功能异常的妇女更易发生妊娠并发症。对EH妇女孕前进行CCB、ACEI治疗,可以降低未来妊娠并发症的发病率。

Objective:To evaluate the cardiac structure and function of patients with essential hypertension(EH)before pregnancy by echocardiography,to assess women’s pre-pregnancy hemodynamics and left ventricular characteristics,and to explore the relationship between pregnancy complications and EH treatment drugs before pregnancy.Methods:According to the incidence of complication during pregnancy,patients were divided into no pregnancy complication group and pregnancy complication group.The socio-demographic data,medical history,anti-EH drug treatment status,cardiac ultrasound parameters and hemodynamic parameters of the two groups were compared and analyzed.Logisitic regression analysis was used to explore the related factors affecting the incidence of pregnancy complications in EH women.Results:In 337 EH patients,239 had no pregnancy complications and 98 cases had pregnancy complications.The rate of normal left ventricular geometry in no pregnancy complication group(44.77%)was significantly higher than that in pregnancy complication group(15.31%).Age,high body mass index,multiple births,strong systemic circulation resistance,left ventricular centripetal remodeling and abnormal left ventricular diastolic function were the risk factors for pregnancy complications in EH women(P<0.05).The use of CCB and ACEI before pregnancy was the protective factor for pregnancy complications in EH women(P<0.05).Conclusion:Women with abnormal cardiac remodeling and left ventricular diastolic function before pregnancy are more likely to have pregnancy complications.Treating EH women with CCB and ACEI before pregnancy can reduce the incidence of pregnancy complications.