晚孕期高危妊娠孕妇心力储备异常高危因素调查及心音图试验在评估孕妇心力储备中的意义  

High-risk factors of cardiac contractility reserve in the third trimester of high-risk pregnancy and the significance of phonocardiogram test in evaluation of pregnant women′s cardiac contractility reserve

作　　者：危小庆 杨霄 Wei Xiaoqing;Yang Xiao(Department of Obstetrics,Chengdu Women′s and Children′s Central Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu 611731,Sichuan Province,China)

机构地区：[1]电子科技大学医学院附属妇女儿童医院·成都市妇女儿童中心医院产科

出　　处：《中华妇幼临床医学杂志（电子版）》2019年第5期504-511,共8页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：国家自然科学基金项目(30770551);国家自然科学基金青年基金项目(81202217);成都市妇女儿童中心医院2017年院内课题(1729)~~

摘　　要：目的 探讨影响晚孕期高危妊娠孕妇心力储备(CCR)的高危因素,同时评估心音图试验(PCGT)评估晚孕期孕妇CCR的价值。方法 选择2013年5月1日至7月31日,于成都市妇女儿童中心医院建卡进行产前检查时,被诊断为CCR异常的65例晚孕期(孕龄为28~41+6孕周)高危妊娠孕妇为研究对象,纳入研究组。选择同期,在同一家医院建卡进行产前检查的CCR正常的晚孕期(孕龄为28~41+6孕周)孕妇489例作为对照,纳入对照组。采用PCGT检测CCR相关指标,包括心率、第一心音幅值/第二心音幅值的比值(S1/S2)、心脏舒张期时限/心脏收缩期时限的比值(D/S)和三尖瓣听诊区第一心音幅值与心尖区第一心音幅值的比值(T1/M1)。通过问卷调查、病史采集,收集这2组孕妇的14项可能影响CCR相关指标的因素,并进行多因素非条件logistic回归分析。对CCR指标S1/S2、D/S,与超声心动图检测的心脏射血分数(EF)和心电图检查结果,对诊断晚孕期孕妇心脏功能的一致性进行分析。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求,与受试者本人及其家属签署临床研究知情同意书。结果 ①合并高危妊娠,合并心、脑血管疾病家族史,年龄≥29~35岁,年龄≥35岁,收缩压≥140~160mmHg(1mmHg=0.133kPa)与收缩压≥160mmHg,均为导致晚孕期孕妇心率异常的独立危险因素(OR=3.158、1.816、1.760、1.901、6.066、17.055,95%CI:1.555~6.415、1.156~2.853、1.046~2.960、1.132~3.194、1.131~32.548、2.353~123.599;P=0.001、0.010、0.033、0.015、0.035、0.005)。孕妇文化程度为大专及以上,则是CCR指标心率的独立保护因素(OR=0.529,95%CI:0.321~0.870;P=0.012)。②晚孕期孕妇孕龄为32~34+6孕周,合并高危妊娠,收缩压≥140~160mmHg与收缩压≥160mmHg,均为导致晚孕期孕妇CCR指标S1/S2异常的独立危险因素(OR=2.400、5.842、4.293、12.875,95%CI:1.265~4.553、2.966~11.506、1.460~26.467、2.496~113.852;P=0.007、0.Objective To investigate the high-risk factors that may affect the cardiac contractility reserve (CCR) of high-risk pregnant women in the third trimester, and to evaluate the value of the phonocardiogram test (PCGT) in assessment of CCR of pregnant women in the third trimester. Methods From May 1, 2013 to July 31, 2013, a total of 65 cases of high-risk pregnant women with CCR abnormalities in the third trimester (28-41 +6 weeks of gestation) in Chengdu Women′s and Children′s Central Hospital were selected as research subjects and included in study group. Simultaneously, others 489 cases of normal CCR pregnant women in the third trimester (28-41 +6 gestational weeks) during the same period and in the same hospital were selected as control and included in control group. PCGT were used to measure CCR-related indicators, including heart rate, ratio of the amplitude of the first heart sound to the second heart sound (S1/S2), ratio of diastolic to systolic duration (D/S), and ratio of S1 amplitude at tricuspid valve auscultation area to that at mitral auscultation area (T1/M1). Through questionnaires and medical history taking, 14 factors that might affect CCR-related indicators between two groups of pregnant women were collected, and multivariate unconditional logistic regression analysis was performed to analyze the high-risk factors that might affect the CCR of pregnant women in the third trimester. The consistency of CCR indexes S1/S2, D/S and echocardiographic detection of cardiac ejection fraction (EF) and electrocardiogram results in diagnosis of cardiac function in pregnant women in the third trimester were analyzed. This study was in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013. All participants confirmed and signed consent forms for clinical trials. Results ①Combined with high-risk pregnancies, combined with family history of cardiovascular and cerebrovascular diseases,≥29-35 years old,≥35 years old, systolic blood pressure ≥ 140-160 mmHg (1 mmHg=

关 键 词：心肌收缩 心力储备 心音图试验 心率 第一心音幅值/第二心音幅值 心脏舒张期时限/心脏收缩期时限 三尖瓣听诊区第一心音幅值/心尖区第一心音幅值 妊娠末期 孕妇 

分 类 号：R714.252[医药卫生—妇产科学]