Katz V L, Ryder R M, Cefalo R C, Carmichael S C, Goolsby R
Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill.
Obstet Gynecol. 1990 Feb;75(2):147-51.
Bed rest and immersion both lead to a mobilization of extravascular fluid and thus reduce edema. This study compared three treatments for edema in healthy pregnant women in the third trimester: lateral supine bed rest at room temperature, sitting in a bathtub of waist-deep water at 32 +/- 0.5C with legs horizontal, and sitting immersed in shoulder-deep water at 32 +/- 0.5C with legs extended downward. Post-treatment diuresis was selected as the indicator of extravascular fluid mobilization. The mean (+/- SD) diuresis was 105 +/- 48, 161 +/- 155, or 242 +/- 161 mL/hour for bed rest, bathtub, and immersion tank, respectively (P less than .008, tank versus bed rest; P less than .05, tank versus bath). In all treatments, mean arterial pressure (MAP) declined from a baseline value of 88 +/- 9 to 77 +/- 10 mmHg 25 minutes into treatment and 77 +/- 11 mmHg at 50 minutes (both P less than .0001 compared with pre-treatment). Shoulder-deep immersion produced the greatest decline in MAP. Sodium clearance increased from 0.7 to 1.0 mEq/minute in all treatments (P less than .01). Serum sodium, potassium, creatinine, osmolarity, total protein, 6-keto prostaglandin F1 alpha, and plasma volume did not change significantly after the treatments. Serum prolactin declined significantly from 137.8 +/- 44 to 124 +/- 31 ng/mL after treatment; there was no difference among treatments. Immersion appears to be a safe and more rapid method than bed rest to mobilize extravascular fluid during pregnancy.
卧床休息和浸泡均会导致血管外液动员，从而减轻水肿。本研究比较了三种针对孕晚期健康孕妇水肿的治疗方法：室温下侧卧位卧床休息、坐在水温为32±0.5℃且水深至腰部的浴缸中，双腿水平放置、以及坐在水温为32±0.5℃且水深至肩部的水箱中，双腿向下伸展。将治疗后的利尿作用选为血管外液动员的指标。卧床休息、浴缸浸泡和水箱浸泡的平均（±标准差）利尿量分别为105±48、161±155或242±161毫升/小时（P<0.008，水箱浸泡与卧床休息相比；P<0.05，水箱浸泡与浴缸浸泡相比）。在所有治疗中，平均动脉压（MAP）在治疗开始25分钟时从基线值88±9降至77±10 mmHg，在50分钟时降至77±11 mmHg（与治疗前相比，两者P均<0.0001）。肩部深度浸泡导致MAP下降幅度最大。所有治疗中钠清除率从0.7增加到1.0毫当量/分钟（P<0.01）。治疗后血清钠、钾、肌酐、渗透压、总蛋白、6-酮前列腺素F1α和血浆容量均无显著变化。治疗后血清催乳素从137.8±44显著降至124±31 ng/mL；各治疗组之间无差异。浸泡似乎是一种比卧床休息更安全、更快速的在孕期动员血管外液的方法。
