适龄健康足月孕妇产程中心输出量的变化  

Changes of cardiac output during labor in healthy term pregnant women of reproductive age

作　　者：魏行玉 张蕾[1] 常颖[1] 陈叙[1] Wei Xingyu;Zhang Lei;Chang Ying;Chen Xu(Department of Obstetrics,Tianjin Central Hospital of Obstetrics and Gynecology,Tianjin Key Laboratory of Human Development and Reproductive Regulation,Tianjin 300100,China)

机构地区：[1]天津市中心妇产科医院产科天津市人类发育与生殖调控重点实验室,天津300100

出　　处：《中华围产医学杂志》2022年第5期343-348,共6页Chinese Journal of Perinatal Medicine

摘　　要：目的了解适龄健康足月孕妇产程中心输出量相关指标的变化趋势。方法前瞻性纳入2020年10月至2021年3月在天津市中心妇产科医院住院的适龄健康足月临产孕妇208例,分别在潜伏期、活跃期、第二产程的宫缩期和宫缩间歇期以及产后1 h共7个时间点进行超声心动图检查获取超声心动图指标包括主动脉根部内径、主动脉瓣瓣环的速度时间积分及心率,通过计算得到每搏输出量、心输出量及心脏指数。组间比较采用t检验、方差分析或Wilcoxon检验。宫缩期及宫缩间歇期的相关指标的比较采用配对t检验,产程各时期心输出量相关指标的比较采用重复测量设计方差分析。结果(1)产程各时期宫缩间歇期与宫缩期比较:潜伏期中宫缩期心率、每搏输出量、心输出量及心脏指数均高于宫缩间歇期[分别为79次/min(72~84次/min)与76次/min(70~85)次/min、(77.9±13.4)与(71.1±12.8)ml、(6.9±1.2)与(5.5±1.1)L/min、(3.5±0.7)与(3.1±0.6)L/(min·m2),Z或t值分别为-2.03、-13.98、-14.19及-14.29,P值均<<0.05];活跃期、第二产程宫缩期也均高于宫缩间歇期(P值均<0.05)。(2)产程各期心输出量相关指标的比较:宫缩间歇期:随产程进展,心率、心输出量及心脏指数逐渐升高,在第二产程达高峰,在产后1 h下降(P值均<<0.05);而每搏输出量总体变化无统计学意义(P=0.366)。宫缩期:随产程进展,心率、心输出量及心脏指数逐渐升高,在第二产程达高峰,在产后1 h下降;而每搏输出量呈下降趋势,至第二产程降至最低(P值均<0.05)。结论适龄健康足月孕妇产程中心输出量相关指标变化显著,尤其在第二产程。因此,正确监测和管理分娩期血流动力学,对分娩期心血管功能的稳定有非常重要的作用。Objective To assess the changes of cardiac output(CO)-related indices in healthy term reproductive age pregnant women during labor.Methods A prospective longitudinal study was conducted,involving 208 pregnant women at term who were at an reproductive age and admitted to the labor ward of Tianjin Central Hospital of Obstetrics and Gynecology from October 2020 to March 2021.The internal diameter of the aortic root,velocity-time integral of aortic valve flow,and heart rate were obtained through transthoracic echocardiography during uterine contractions period and the intervals between contractions in the latent phase,active phase,and the second stage of labor,as well as at one hour after delivery.Stroke volume(SV),CO,and cardiac index(CI)were then calculated.Comparisons among groups were performed using t-test,analysis of variance,or Wilcoxon test.CO-related indices during contractions periods and intervals between contractions were compared using paired t-test,those in each stage of labor using repeated measurement analysis of variance.Results(1)CO-related indices in contractions periods vs intervals between contractions during labor:In the latent phase,maternal heart rate[79(72−-84)vs 76(70−-85)bpm,Z=-2.03,P<<0.05],SV[(77.9±13.4)vs(71.1±12.8)ml,t=-13.98,P<<0.05],CO[(6.1±±1.2)vs(5.5±±1.1)L/min,t=-14.19,P<<0.05],and CI[(3.5±±0.7)vs(3.1±±0.6)L/(min·m2),t=-14.29,P<<0.05]during contractions were higher than those during the intervals.These parameters during contractions in the active phase and the second stage of labor were all higher than those during the intervals in the same stage(all P<<0.05).(2)CO-related indices in each period of labor:Heart rate,CO,and CI during the intervals between contractions gradually increased along with labor progression and reached the peak at the second stage followed by a decrease at one hour after delivery,and a similar trend was also observed for these parameters during contractions in the whole labor(all P<<0.05).No significant changes in the maternal SV during interv

关 键 词：妊娠 分娩 产道 产程 第二 每搏输出量 心排血量 超声心动描记术 

分 类 号：R714[医药卫生—妇产科学]