Ekholm E M, Erkkola R U
Department of Obstetrics and Gynecology, Turku University Hospital, Finland.
Eur J Obstet Gynecol Reprod Biol. 1996 Jan;64(1):29-36. doi: 10.1016/0301-2115(95)02255-4.
Pregnancy is associated with profound adaptive changes in the maternal hemodynamics. Although the autonomic nervous system plays a central role in the adaptation of the cardiovascular system to various needs, its role in the adaptation of the circulation to the demands of pregnancy is poorly understood. This paper reviews the literature of autonomic cardiovascular control in pregnancy as studied with the cardiovascular reflex tests. A Medline search and manual cross-referencing for prior publications were used. All papers found on the hemodynamic effects of the Valsalva maneuver, the orthostatic test, the deep breathing test, the isometric handgrip test and maternal heart rate variability in pregnancy were reviewed and all publications that studied short-term changes in maternal heart rate and blood pressure were included. The beginning of pregnancy is associated with sympathetic reactivity, whereas the latter half of pregnancy is characterized by increased hemodynamic stability during orthostatic stress. The heart rate response to the Valsalva maneuver is blunted in mid-pregnancy, possibly due to changes in the baroreflex and increased maternal blood volume. Heart rate variability is significantly reduced in the second trimester. Cardiovascular reflex tests can be used to study drug effects on maternal circulation non-invasively.
妊娠与母体血液动力学的深刻适应性变化相关。尽管自主神经系统在心血管系统适应各种需求的过程中起着核心作用，但其在循环系统适应妊娠需求方面的作用仍知之甚少。本文回顾了通过心血管反射试验研究妊娠期间自主心血管控制的文献。使用了医学文献数据库检索和对先前出版物的手动交叉引用。对所有关于瓦尔萨尔瓦动作、直立试验、深呼吸试验、等长握力试验的血液动力学效应以及妊娠期间母体心率变异性的论文进行了综述，并纳入了所有研究母体心率和血压短期变化的出版物。妊娠初期与交感神经反应性有关，而妊娠后半期的特征是在直立应激期间血液动力学稳定性增加。妊娠中期对瓦尔萨尔瓦动作的心率反应减弱，这可能是由于压力反射的变化和母体血容量增加所致。妊娠中期心率变异性显著降低。心血管反射试验可用于无创研究药物对母体循环的影响。
