妊娠高血压疾病患者孕期外周母体血液动力学变化。

Peripheral maternal haemodynamics across pregnancy in hypertensive disorders of pregnancy.

机构信息

Robinson Research Institute, University of Adelaide, Adelaide, Australia; Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Adelaide Medical School, University of Adelaide, Adelaide, Australia.

Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia.

出版信息

Pregnancy Hypertens. 2019 Apr;16:89-96. doi: 10.1016/j.preghy.2019.02.006. Epub 2019 Feb 23.

DOI:10.1016/j.preghy.2019.02.006

PMID:31056165

Abstract

OBJECTIVES

Evaluating maternal haemodynamics across pregnancy in uncomplicated pregnancies and those complicated by hypertensive disorders of pregnancy (HDP).

STUDY DESIGN

Prospective cohort study from 2015 to 2018 of healthy, nulliparous, singleton-bearing women. Maternal haemodynamics assessed by Uscom BP+ at 9-16 and 32-36 weeks' gestation in pregnancies complicated by HDP [preeclampsia with severe (sPE n = 12) and without severe clinical features (nsPE n = 49), gestational hypertension (GH n = 25), transient gestational hypertension (TGH n = 33)] were compared to uncomplicated pregnancies (n = 286) using mixed-effects linear modelling.

MAIN OUTCOME MEASURES

Maternal haemodynamic adaptation in uncomplicated pregnancies and those complicated by HDP.

RESULTS

Between the two measurements, haemodynamic adaptation in women with sPE and nsPE was significantly different compared to those with uncomplicated pregnancies. An additional increase was observed for peripheral systolic blood pressure [SBP; 14.3 mmHg, 8.6-20.1 (sPE)], peripheral diastolic blood pressure [DBP; 7.7 mmHg, 3.3-12.1 (sPE); 2.6 mmHg, 3.3-12.1 (nsPE)] peripheral mean arterial pressure [MAP; 10.6 mmHg, 5.8-15.5 (sPE); 3.4 mmHg, 0.8-6.0 (nsPE)], peripheral pulse pressure [PP; 6.6 mmHg, 2.1-11.1 (sPE)], central SBP [15.8 mmHg, 10.4-21.2 (sPE); 2.9 mmHg, 0.1-5.8 (nsPE)], central DBP [8.3 mmHg, 3.9-12.6 (sPE); 2.5 mmHg, 0.2-4.8 (nsPE), central MAP [10.8 mmHg, 6.4-15.2 (sPE); 2.6 mmHg, 0.3-5.0 (nsPE)] and central PP [7.6 mmHg, 3.9-11.3 (sPE)]. Augmentation index (AIx) decreased less (15.5%, 6.3-24.6 (sPE); 9.0%, 4.2-13.6 (nsPE)] compared to uncomplicated pregnancies. Haemodynamic adaptation across pregnancy in women with GH and TGH was not different from those with uncomplicated pregnancies.

CONCLUSION

Women who develop preeclampsia show an altered, while those who develop GH or TGH demonstrate a comparable haemodynamic adaptation compared to uncomplicated pregnancies. TGH is not a benign condition.

摘要

目的

评估正常妊娠和妊娠合并高血压疾病（HDP）孕妇的孕期母体血液动力学变化。

研究设计

2015 年至 2018 年进行的一项前瞻性队列研究，纳入健康、初产、单胎妊娠的女性。使用 Uscom BP+在妊娠 9-16 周和 32-36 周评估 HDP 孕妇（子痫前期伴重度（sPE，n=12）和无重度临床特征（nsPE，n=49）、妊娠期高血压（GH，n=25）、一过性妊娠期高血压（TGH，n=33））的母体血液动力学，并与正常妊娠（n=286）进行比较，采用混合效应线性模型。

主要观察指标

正常妊娠和 HDP 孕妇的母体血液动力学适应性。

结果

与正常妊娠相比，sPE 和 nsPE 孕妇在两次测量之间的血液动力学适应性明显不同。外周收缩压[SBP；14.3mmHg，8.6-20.1（sPE）]、外周舒张压[DBP；7.7mmHg，3.3-12.1（sPE）；2.6mmHg，3.3-12.1（nsPE）]、外周平均动脉压[MAP；10.6mmHg，5.8-15.5（sPE）；3.4mmHg，0.8-6.0（nsPE）]、外周脉搏压[PP；6.6mmHg，2.1-11.1（sPE）]、中心 SBP[15.8mmHg，10.4-21.2（sPE）；2.9mmHg，0.1-5.8（nsPE）]、中心 DBP[8.3mmHg，3.9-12.6（sPE）；2.5mmHg，0.2-4.8（nsPE）]、中心 MAP[10.8mmHg，6.4-15.2（sPE）；2.6mmHg，0.3-5.0（nsPE）]和中心 PP[7.6mmHg，3.9-11.3（sPE）]均有显著增加。与正常妊娠相比，反射波增强指数（AIx）降低较少（15.5%，6.3-24.6（sPE）；9.0%，4.2-13.6（nsPE））。GH 和 TGH 孕妇的孕期血液动力学变化与正常妊娠无差异。