Yang J M, Yang Y C, Wang K G
Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C.
Acta Obstet Gynecol Scand. 1996 Feb;75(2):120-6. doi: 10.3109/00016349609033302.
Doppler velocimetry, a new tool for measuring blood flow, vascular resistance, and central hemodynamics can be applied to monitor those patients at risk and provide therapeutic concepts for preeclampsia. This study was designed to use a Doppler velocimetry study to correlate the relationship between central hemodynamics, uteroplacental circulation, and the perinatal outcome in severe preeclampsia.
Thirty-one patients with severe preeclampsia, not superimposed with any medical disorder and not on antihypertensive treatment prior to admission, were enrolled in this study. On admission, laboratory determination of the maternal blood chemistry and hematogram, together with a Doppler ultrasound study of the maternal hemodynamics, and umbilical and uterine arteries, were performed. Antihypertensive agents including hydralazine, atenolol, and labetolol were given according to the state of the maternal central hemodynamics. Data were collected on the general status of the patients, the results of the Doppler ultrasound study, and the perinatal outcome.
Patients were divided into three groups based on the systemic vascular resistance. The left ventricular function and cardiac index declined with increase in vascular resistance. The high-resistance group had a significantly high incidence of infants small for gestational age. Poor fetal growth in the high-resistance group could be attributed to the summation of underperfusion due to decreased uteroplacental blood flow and was frequently associated with maternal hemoconcentration.
Although global vasospasm has been considered to be the basic pathophysiology of preeclampsia, the central hemodynamics varies between, and even in the same, patients. Regional vasospasm in the uteroplacental circulation occurs earlier than in the systemic circulation as a whole. A high cardiac-output in low systemic-vascular-resistance might compensate in those pregnancies with high uterine artery resistance to maintain adequate uteroplacental perfusion.
多普勒测速技术是一种用于测量血流、血管阻力和中心血流动力学的新工具，可应用于监测高危患者，并为子痫前期提供治疗方案。本研究旨在通过多普勒测速研究，探讨重度子痫前期患者中心血流动力学、子宫胎盘循环与围产儿结局之间的关系。
本研究纳入了31例重度子痫前期患者，这些患者未合并任何内科疾病，入院前未接受降压治疗。入院时，进行了母体血液化学和血常规的实验室测定，同时进行了母体血流动力学、脐动脉和子宫动脉的多普勒超声检查。根据母体中心血流动力学状态给予包括肼屈嗪、阿替洛尔和拉贝洛尔在内的降压药物。收集了患者的一般情况、多普勒超声检查结果和围产儿结局的数据。
根据全身血管阻力将患者分为三组。左心室功能和心脏指数随血管阻力增加而下降。高阻力组小于胎龄儿的发生率显著较高。高阻力组胎儿生长受限可归因于子宫胎盘血流减少导致的灌注不足总和，且常与母体血液浓缩有关。
尽管全身血管痉挛被认为是子痫前期的基本病理生理学，但中心血流动力学在不同患者之间甚至同一患者体内都有所不同。子宫胎盘循环中的局部血管痉挛比整个体循环中出现得更早。低全身血管阻力时的高心输出量可能在子宫动脉阻力高的妊娠中起到代偿作用，以维持足够的子宫胎盘灌注。
