中孕期24h动态血压监测的临床意义

目的通过对妊娠中期孕妇动态血压监测及妊娠结局的追踪,研究动态血压监测在妊娠中期预测妊娠期高血压发病的意义。方法随机选取2007年3月至2007年8月在首都医科大学附属北京妇产医院产前检查并分娩的正常单胎妊娠孕妇200例,孕20～24周,当时无合并症,行24h动态血压监测(ambulatory blood pressure monitoring,ABPM),并追踪其妊娠结局,进行比较。结果200例妊娠中期孕妇中发现白衣型高血压70例,追踪妊娠结局正常血压组89例,妊娠高血压组23例,原发型高血压组18例。对后3组孕妇妊娠中期24h平均收缩压(24hSBP)及舒张压(24hDBP),白天平均收缩(dSBP)及舒张压(dDBP),夜间平均收缩压(nSBP)及舒张压(nDBP)的结果进行了比较。正常血压、妊娠高血压组间比较差异无统计学意义,但妊娠高血压组夜间平均舒张压似有升高的趋势。原发型高血压组与另2组比较差异有统计学意义(P<0.05)。对3组孕妇24h血压昼夜节律进行了比较,原发型高血压组与另2组间差异有统计学意义(P<0.05)。结论在妊娠中期单次进行24h动态血压监测,对预测妊娠期高血压预防无明确意义。对结果可疑及高危人群应定期重复监测可早期诊断治疗,改善母儿预后;对妊娠中期孕妇进行24h动态血压监测可早期诊断白大衣性高血压,及早进行临床干预,可增加正常分娩率,促进母儿健康。

Clinical Significance of Ambulatory 24-hour Blood Pressure Monitoring during Middle Pregnancy

Objective To investigate the significance of the ambulatory 24-hour blood pressure monitoring during middle pregnancy in the outcomes of pregnancy and in predicting hypertensive disorder complicating pregnancy. Methods Data of 200 pregnant women chosen at random from March 2007 to August 2007 in Beijing Obstetrics and Gyneology Hospital were analyzed. All these women had single-fetus pregnancy and were at 20~24 weeks of gestation without any complication. Ambulatory 24-hour blood pressure monitoring(ABPM) was conducted for all the subjects and the outcomes of the pregnancy were observed and recorded. Results Seventy of the cases had white-coat hypertension, 89 cases were normotensive at the end of pregnancy, 23 cases developed hypertensive disorder complicating pregnancy, and 18 cases had primary hypertension. The comparisons were carried out among the four groups in 24 hours systolic blood pressure(24 h SBP), 24 hours diastolic blood pressure(24 h DBP), day systolic blood pressure(dSBP) and night diastolic blood pressure(nDBP). The normotensive group and the hypertensive disorder complicating pregnancy group had no significant difference in the four indexes, but the latter had higher nDBP. The primary hypertension group and the other two groups had significant difference in the four indexs(P<0.05). The onormotensive group and the other groups had significant difference in the circadian blood pressure(P<0.05). Conclusion Single 24-hour blood pressure monitoring during the middle pregnancy had no definite significance in predicting hypertensive disorder that may complicate pregnancy, but repeated blood pressure monitoring in high risk group may be beneficial to outcomes through early diagnosis and treatment. The 24-hour blood pressure monitoring could diagnose white-coat hypertension early.