Elvan-Taşpinar Ayten, Franx Arie, Delprat Constance C, Bruinse Hein W, Koomans Hein A
Department of Perinatology and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands.
Am J Obstet Gynecol. 2006 Dec;195(6):1590-5. doi: 10.1016/j.ajog.2006.05.007. Epub 2006 Jul 26.
Preeclampsia is associated with profound vasoconstriction in most organ systems and reduced plasma volume. Because water immersion produces a marked central redistribution of blood volume and suppresses the renin-angiotensin system response and sympathetic activity, we hypothesized that water immersion might be useful in the treatment of preeclampsia.
The effects of thermoneutral water immersion for 3 hours on central and peripheral hemodynamics were evaluated in 7 preeclamptic patients, 7 normal pregnant control patients, and 7 nonpregnant women. Finger plethysmography was used to determine hemodynamic measurements (cardiac output and total peripheral resistance), and forearm blood flow was measured by strain gauge plethysmography. Postischemic hyperemia was used to determine endothelium-dependent vasodilation. Analysis was by analysis of variance for repeated measurements.
During water immersion cardiac output increased while diastolic blood pressure and heart rate decreased, although systolic blood pressure remained unchanged in each group. Forearm blood flow increased significantly in the normal pregnant and preeclamptic subjects. Total peripheral resistance decreased in all groups, but values in preeclamptic patients remained above those of normotensive pregnant women. Water immersion had no effect on endothelium-dependent vasodilation in the preeclamptic group, and most hemodynamic changes that were observed reversed to baseline within 2 hours of completion of the procedure.
Although water immersion results in hemodynamic alterations in a manner that is theoretically therapeutic for women with preeclampsia, the effect was limited and short-lived. In addition water immersion had no effect on endothelium-dependent vasodilation in women with preeclampsia. The therapeutic potential for water immersion in preeclampsia appears to be limited.
子痫前期与多数器官系统的严重血管收缩及血容量减少有关。由于水浸浴可使血容量显著重新分布至中心循环，并抑制肾素 - 血管紧张素系统反应及交感神经活动，我们推测水浸浴可能有助于子痫前期的治疗。
对7名单纯收缩期高血压患者、7名正常妊娠对照者及7名非妊娠女性评估了3小时热中性水浸浴对中心和外周血流动力学的影响。采用手指体积描记法测定血流动力学指标（心输出量和总外周阻力），并通过应变片体积描记法测量前臂血流量。采用缺血后充血来测定内皮依赖性血管舒张功能。分析采用重复测量方差分析。
水浸浴期间，心输出量增加，舒张压和心率下降，尽管每组收缩压保持不变。正常妊娠和子痫前期受试者的前臂血流量显著增加。所有组的总外周阻力均下降，但子痫前期患者的值仍高于血压正常的孕妇。水浸浴对子痫前期组的内皮依赖性血管舒张功能无影响，且观察到的大多数血流动力学变化在操作完成后两小时内恢复至基线水平。
尽管水浸浴导致的血流动力学改变在理论上对患有子痫前期的女性具有治疗作用，但其效果有限且持续时间短。此外，水浸浴对子痫前期女性的内皮依赖性血管舒张功能无影响。水浸浴在子痫前期中的治疗潜力似乎有限。
