摘要
目的:用无创血流动力学监测系统检测子痫前期患者的血流动力学变化,分析其与肾功能损害的关系。方法:选择南京医科大学附属南京妇幼保健院2009年1月5日至2011年10月12日待产分娩的子痫前期患者314例(子痫前期组),妊娠期高血压患者250例(妊娠期高血压组)和正常妊娠孕妇76例(正常妊娠组)为研究对象。检测每位孕妇的尿蛋白、血肌酐(Scr)、血尿素氮(BUN)、血尿酸(UA)和肾小球滤过率(GFR),并进行比较;同时将子痫前期组中,GFR<90ml/min/1.73m2的患者分为子痫前期伴肾功能损害亚组,GFR≥90ml/min/1.73m2的患者为子痫前期无肾功能损害亚组,对比两个亚组间孕妇血流动力学参数:心率(HR)、平均动脉压(MAP)、心脏指数(CI)、心输出量(CO)、每搏指数(SI)、每搏量(SV)、周围血管阻力指数(SVRI)、周围血管阻力(SVR)、心肌加速度指数(ACI)、速度指数(VI)的变化。结果:①子痫前期组患者Scr、BUN和UA较妊娠期高血压组和正常妊娠组明显升高(P<0.05),而GFR明显降低(P<0.05)。②子痫前期组出现BUN、UA异常以及中度或轻度的肾功能损害(GFR<90ml/min/1.73m2)的发生率明显高于妊娠期高血压组和正常妊娠组(P<0.05)。③子痫前期伴肾功能损害亚组外周血管阻力(SVRI、SVR)明显高于无肾功能损害亚组(P<0.01),而心排出量(CI、CO)及心脏收缩功能(SI、SV、VI)明显低于无肾功能损害亚组(P<0.01)。结论:子痫前期可出现肾功能损害,其孕妇心输出量的下降和外周阻力的升高是发生肾功能损害的重要因素。
Objective： To detect the hemodynamic alterations by noninvasive hemodynamic monitoring system in preeclamptic women for analyzing the relationship with renal impairmen Methods： 314 women i with preeclampsia （PE） ,250 women with pregnancy-induced hypertension （PIH） ,and 76 nomal pregnancy （NP）who were admitted in Maternal-Child Health Centers affiliated to Nanjing Medical University were en- rolled in this study. The urinary protein excretion,serum creatinine （Scr）,blood urea nitrogen （BUN）, uric acid （UA）, glomerular filtration rate （GFR）of each women were tested and compared. The PE group was subdivided into two subgroups with or without had renal impairment （GFR 〈 90 ml/min/1.73 min = 60 vs G FR ~〉 90 ml/min/1.73 m 2, n = 254）. The hemodynamic parameters, namely, heart .rate （ HR）, mean arterial pressure （ MAP）, cardiac index （ CI ）, cardiac output （ CO ）, stroke index （ SI ）, stroke volume （ SV）, peripheral vascular resistance index （ SVRI ）, peripheral vascular resistance （ SVR ）, myocardiac acceleration index （ ACI）, velocity index（Vl） were compared between the two subgroups. Results ：The Scr, BUN and UA lev- els in PE group were significantly higher than those in the other two groups（ P 〈 0.05）, while the GFR was markedly dropped（ P 〈 0.05）.ln the PE group,the incidence of BUN ＆ UA abnormality and light to moder- aterenal impairment （GFR 〈 90 ml/min/1.73m2） were significantly higher than those in the other two groups （ P 〈0.05）. （~ SVRI and SVR in the renal-impairment PE subgroup were remarkably higher than those in the other subgroup（P〈0.01 ）,while maternal SI,SV,CI and CO values in the renal-impairment PE subgroup were significantly lower than those in theother subgroup （ P 〈 0.01 ）. Conclusions： Preeclampsia could lead to renal impairment ,which is mainly caused by decreased cardiac output and increased peripheral vascular resistance.
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2012年第9期751-754,共4页
Journal of Practical Obstetrics and Gynecology
基金
江苏省自然科学基金面上项目(编号:BK2011106)
南京市医学科技发展-青年科技人才启动项目(编号:QYK11141)
关键词
血流动力学检测
子痫前期
妊娠期高血压
肾功能
肾小球滤过率
Hemodynamic monitoring
Preeclampsia
Gestational hypertension
Renal function
Glomeru-lar filtration rate
