重度子痫前期患者血压昼夜节律变化对胎儿血流动力学的影响

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1、·22t4·查垦兰旦!!塑笙堂笙!塑!!竺lJournalSep．2010；Vo1．31，No．～17重度子痫前期患者血压昼夜节律变化对胎儿血流动力学的影响吕莉娟，牛建民，温济英，雷琼，刘国成，林小红广东省妇幼保健院产科(广州510010)【摘要】目的检测重度子痫前期患者血压为杓型和非杓型昼夜节律对胎儿血流动力学的影响。方法选取住院重度子痫前期患者65例，其中血压昼夜节律为非杓型45例，杓型20例；另选取同期住院分娩的孕妇7O例为对照组。(1)动态血压监测所有患者白天与夜间的血压，并根据血压昼夜节律将患者分为杓型和非杓型。(2)彩色超声多普勒测量胎儿脐动脉、腹主

2、动脉、肾动脉、大脑中动脉和母体子宫动脉的S／D、PI、RI值．比较其与血压昼夜节律的相关性。结果(1)3组夜间舒张压的差畀最显著，非杓形组的夜平均舒张压和舒张压昼夜节律均较杓形组显著升高(P<0．05)；(2)非杓形组脐动脉S／D、RI较杓形组和对照组均有显著性升高(P<0．05)；子宫动脉S／D、RI和大脑中动脉的PI较对照组也有显著性升高(P<0．05)；(3)3组脐动脉S／D值与新生儿体重呈正相关(P<0．05)。结论非杓型昼夜节律的血压对胎儿生长发育及围生期结局均有不利影响，降压应以夜间治疗为重点并且足量。【关键词】子痫前期；动态血压监测；血压昼夜节律；

3、超声检查，多普勒，彩色RelationshipbetweencircadianbloodpressurerhythmandfetaJhemodynamicsinwomenwitIIseverepreeelamp-sia．LVb—juan．NIUJian—min，WENjt—ying，LEIQiong，uUGuo—cheng，LlNXiao—hong．DepartmentofOb—stertrics．GuangdongWomenandChildren'sHospitalandHealthInstitute，Guangzhou510010，ChinaCorrespo

4、ndingauthor：NIUJian—min【Abstract】ObjectiveTostudytheeffectsofdifferentcircadianbloodpressurerhythmsonfetalcirculatorysys—terninwomenwithseverepreeclampsia．MethodsThestudyincluded65gravidaewithseverepreeclampsia(45and20gravidaewithnon—dipperbloodpressureanddipperbloodpressure，respecti

5、vely)and70healthgravidaeaspreeclampsiagroupandcontrolgroup，respectively．(1)ABPMwasusedtomeasurediurnalandnocturnalmaternalbloodpressure，ac—cordingtowhichgravidaeweredividedintodipperandnon—dippergroups．(2)Colordoppleruhrasonographywasusedtoassessthesystolictodiastolicvelocityratios(S

6、／D)，pulsatility(PI)andresistanceindices(RI)ofmaternaluterineartery，fetalumbilicalartery，aortaartery，fetalrenalarteryandfetalmiddlecerebralartery．Results(1)Themostprominentfluctuationwasobservedindiastolicpressureofallsubjects．Furthermore，nocturnaldiastolicpressureandcir-cadianrhythmo

7、fdiastolicpressureweresignificantlyhigherinnon—dippergroupthanthoseindippergroup(P<0．05)．(2)S／DandRIofumbilicalarteryinweresignificantlyhigherthanthoseindipperandcontrolgroup，respectively(P<0．05)．Meanwhile，S／DandRIofuterineartery，andPIoffetalmiddlecerebralarteryweresignificantlyhighe

8、rinnon—dippe