国际妇产科学杂志

国际妇产科学杂志 ›› 2015, Vol. 42 ›› Issue (5): 536-539.

• 论著 • 上一篇    下一篇

重度子痫前期和（或）妊娠期肝内胆汁淤积症血流动力学改变对妊娠结局的影响

王晶，刘晓军，王静，丁亚芹   

  1. 230032 合肥，安徽医科大学第一附属医院妇产科（王晶，刘晓军，丁亚芹）；安徽医科大学公共卫生学院（王静）
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2015-10-15 发布日期:2015-10-15
  • 通讯作者: 王晶

The Affection of Hemodynamic Changes of Patients with Severe PE or/combined with ICP to Pregnancy Result

WANG Jing，LIU Xiao-jun，WANG Jing，DING Ya-qin   

  1. Department of Obstetrics and Gynecology，The First Affiliated Hospital of Anhui Medical University，Hefei 230032，China（WANG Jing，LIU Xiao-jun，DING Ya-qin）；School of Public Health，Anhui Medical University，Hefei 230022，China（WANG Jing）
  • Received:1900-01-01 Revised:1900-01-01 Published:2015-10-15 Online:2015-10-15
  • Contact: WANG Jing

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摘要： 目的：用无创血流动力学检测系统研究重度子痫前期（PE）、重度妊娠期肝内胆汁淤积症（ICP）及这两种合并症并存的妊娠妇女血流动力学变化对妊娠结局的影响。方法：选择2011年1月—2013年6月在安徽医科大学第一附属医院门诊产检及住院的妊娠妇女176例，孕30～35周，根据病情分为重度ICP组（n=32）、重度PE组（n=81）、重度PE合并ICP组（n=25）和正常对照组（n=38）。对各组妊娠妇女进行血流动力学、心脏彩色超声、血生化检测，并随访妊娠结局。结果：重度PE合并ICP组的胎儿生长受限（FGR）及胎儿宫内死亡发生率最高（P＜0.05），胎儿出生即刻评分明显降低（P＜0.05），血流动力学指标中外周血管阻力、血液黏度、心脏指数、心搏指数、外周血管顺应性变化最明显（P＜0.05），左房内径（LA）、左室舒张末期内径（LVD）增大，左室射血分数（EF）最低。重度ICP妊娠妇女血液黏度及外周血管顺应性明显改变（P＜0.05），但是心脏指数、心搏指数、外周血管阻力、LA、LVD和EF平均值与对照组比较差异无统计学意义（P ＞0.05），该组FGR发生率增加（P＜0.05）。另外，血液黏度的增加与FGR密切相关（OR=2.973，95%CI为2.047～4.319，P＜0.05）。结论：对有高血压，高胆酸的妊娠妇女行无创血流动力学监测结合生化指标变化，可发现胎儿宫内严重缺氧，降低胎死宫内的发生率。

关键词: 先兆子痫, 胆汁淤积, 肝内, 胎儿生长迟缓, 血液流变学, 血液黏度

Abstract: Objective：To investigate the affection of hemodynamic changes to pregnancy results in women suffer from severe preeclampsia or/combined with intrahepatic cholestasis by noninvasive hemodynamic monitoring system. Methods：176 pregnant women were selected and classified into following groups: severe ICP （n=32）, severe preeclampsia （PE, n=81）, severe PE combined with ICP （n=25）, normal control （n=38）. Noninvasive hemodynamic monitoring, cardiac color ultrasonography monitoring, biochemical testing, and delivery information collecting were performed in all patients. Results：FGR and IUFD rates of PE combined with ICP group were the highest （P＜0.05）, and the apgar score （0 min） was the lowest （P＜0.05）. Furthermore, the peripheral vascular resistance, blood viscosity, cardiac index （CI）, stroke index and the peripheral vascular compliance change most distinct in all the hemodynamic index （P＜0.05）, the left atrial diameter （ＬＡ） and left ventricular end diastolic diameter （LVD） were increased, left ventricular ejection fraction （ＥＦ） was the lowest. In severe ICP group, blood viscosity and peripheral arterial compliance were also significantly varied （P＜0.05）. However, CI, heart beat index, peripheral vascular resistance, LA, LVD, and EF average value did not obviously vary （P＞0.05）. Otherwise, the increase of blood viscosity in pregnant women was closely related to FGR（OR=2.973，95%CI：2.047-4.319，P＜0.05）. Conclusions：Noninvasive hemodynamic monitoring system combined with biochemical testing provides another way to monitor the fetal intrauterine hypoxia, and reduce the rate of intrauterine fetal death.

Key words: Pre-eclampsia, Cholestasis, intrahepatic, Fetal growth retardation, Hemorheology, Blood viscosity