轻中度慢性高血压孕期血压维持和控制水平对母儿结局影响研究  

Effects of maintenance and control of blood pressure during pregnancy on maternal and fetal outcomes in mild to moderate chronic hypertension

作　　者：申叶 杨孜[1] 陈杨 石岩岩[2] 

机构地区：[1]北京大学第三医院妇产科,北京100191 [2]北京大学第三医院临床流行病学研究中心,北京100191

出　　处：《中国实用妇科与产科杂志》2018年第1期78-83,共6页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：北京市科技重大专项首都临床特色应用与成果推广(Z171100001017231)

摘　　要：目的探讨妊娠期轻中度慢性高血压患者孕期血压维持和控制水平对母儿结局的影响。方法对2012年1月至2016年12月5年间在北京大学第三医院接受规律产前检查并结束妊娠且资料完整的初始诊断为妊娠合并慢性高血压的302例临床观察资料进行分析,比较孕期血压(blood pressure,BP)维持和控制的不同水平组(A组血压<130/80mm Hg、B组130~139/80~89mm Hg、C组140~149/90~99mm Hg、D组150~159/100~109mm Hg)的临床特征及重度高血压(sever hypertension)、伴蛋白尿的子痫前期(preeclampsia with proteinuria,PE-Pro)、重度子痫前期(sever preeclampsia,SPE)以及小于胎龄儿(small-For-gestational-age,SGA)的发生率。结果慢性高血压血压分级影响分析:孕前或孕早期慢性高血压Ⅲ级患者在孕中期或孕晚期重度高血压和SPE的发生率比高血压Ⅰ级者高(P<0.05),但对PE-Pro、SGA的发生率未见影响(P>0.05)。孕前或孕早期慢性高血压Ⅲ级患者发生PE-Pro、SPE的孕周比高血压Ⅰ级者早(P<0.05),但对重度高血压的发病孕周未见影响(P>0.05)。孕期血压维持和控制水平分析:A组重度高血压、PE-Pro、SPE的发生率比B组低(P<0.05),B组重度高血压的发生率比C组低(P<0.05)。孕期血压维持和控制水平对SGA的发生率未见影响(P>0.05)。多因素分析显示血压维持和控制水平影响重度高血压、PE-Pro、SPE的发生(OR=4.957,95%CI 1.409~17.443;OR=2.388,95%CI 1.446~3.944;OR=1.174,95%CI 1.666~6.047);孕前或孕早期出现蛋白尿(OR=17.693 95%CI 1.800~173.886)是SPE的独立影响因素。肥胖是SGA的保护因素(OR=0.099,95%CI 0.013~0.737),孕期体重增长、血压维持和控制水平是SGA的独立影响因素(OR=0.803,95%CI 0.657~0.982;OR=5.786,95%CI 1.542~1.703)。结论慢性高血压轻中度孕妇孕期血压控制有利于降低重度高血压、子痫前期、重度子痫前期的发生,而且并不对SGA的发生造成影响。Objective To study the effects of the maintaining or control level of blood pressure （BP）during pregnancy among gravidas with mild-to-moderate chronic hypertension on obstetric outcomes.Methods An observational study were conducted in 302 casesinitiallydiagnosed as chronic hypertension, received regular prenatal careand delivered in Peking University Third Hospital from January 2012 to December 2016.Fourgroups were made according to the lever of BP maintained or controlled during pregnancy （Group A： 〈130/80 mmHg, Group B 130-139/80-89 mmHg, Group C： 140- 149/90- 99mmHg, GroupD： 150- 159/100- 109mmHg）.The end point was defined as severe hypertension, preeclampsia with proteinuria （PE- Pro） , severe preeclampsia （SPE） , small- for- gestationalage （SGA）.Results Analysis of the grading of chronic hypertension： the incidence of severe hypertension and SPE during middle or late pregnancy in group hypertension grade Igwas higher than that in hypertension grade I （P〈0.05）, but there was no effect on the incidence of PE-Pro of SGA.The average time of onset of PE-Pro and SPE in group hypertension grade 111 was earlier than hypertension grade I （P〈0.05）, but there was no impact on the average onset time of severe hypertension （P〉0.05）.Analysis of different level of BP maintained or controlled： the level of BP maintained or controlled had an effect on the incidence of severe hypertension and SPE （P〈0.05）, buthad no impacton the incidence of SGA （P〉0.05）.The incidence of severe hypertension and SPE in group A was lower than group B （P〈O.OS）.The incidence of severe hypertension in the group B was lower than group C （P〈0.O5）.3.Multivariate regression analysis showed the level of BP maintained or controlled affected the incidence of severe hypertension, PE-Pro and SPE （OR=4.957, 95% C! 1.409-17.443. OR=2.388, 95% CI 1.446- 3.944; OR= 1.174： 95% CI 1.666- 6.047）.Proteinuria in the early or middle pregnancy was the independent influencing factor of SPE

关 键 词：轻中度高血压 妊娠合并慢性高血压 血压维持和控制水平 小于胎龄儿 子痫前期 

分 类 号：R714.246[医药卫生—妇产科学]