孕妇心脏功能变化与妊娠结局的研究进展

孕妇心脏结构、功能等随孕周发生一系列适应性变化。正常孕妇心脏泵血功能增强，心率加快，心输出量增加，舒张功能及结构也发生改变。当出现孕期并发症，如妊娠期高血压疾病，胎儿生长受限，心脏疾病或双胎妊娠时，孕妇心脏功能发生不同变化。随妊娠期高血压疾病进展程度不同，孕妇心血管系统改变不同。合并妊娠期高血压时，孕妇心脏表现为心输出量增高，全身血管阻力降低；子痫前期临床症状出现前，表现为心输出量增高，全身血管阻力与正常孕妇未见明显差异；子痫前期临床症状出现后，孕妇心输出量降低，全身血管阻力增加，围产结局不良。早发与晚发子痫前期孕妇心脏功能亦表现不同。妊娠合并胎儿生长受限时，孕妇心血管系统呈低排高阻循环状态，表现为心输出量低而全身血管阻力高。妊娠合并心脏疾病时，不同种类疾病心功能受损程度不同，围产结局不同。妊娠早期合并不同疾病孕妇心脏功能已发生相应改变。双胎妊娠孕妇心脏功能不同变化与妊娠结局相关。

Maternal cardiac function and pregnancy outcomes progress research

The morphology and function of maternal heart have adaptive change during pregnancy. Pump function of normal maternal heart is strengthened, heart rate accelerates, cardiac output elevates, along with the changes of diastolic function and structure. When pregnancy complications occur, for example, hypertensive disorders complicating pregnancy, intrauterine growth retardation, heart disease or multiple pregnancy, maternal cardiac function have different changes. The maternal cardiovascular system changes depend on the severity of hypertensive disorders complicating pregnancy. When gestational hypertension happens, maternal cardiac output （CO） increases, and the total vascular resistance （TVR） decreases; pre-eclampsia before clinical manifestation occurs, CO raises and TVR has no difference from normal;but after the clinical manifestation occurs, CO reduces and TVR grows, the perinatal outcome is poor. Maternal cardiac functions of early or late pre-eclampsia also have different manifestations. When pregnancy complicating intrauterine growth retardation, the maternal cardiovascular system presents low output high resistance status. When complicating heart disease, maternal cardiac functions deteriorate differently according to the type of disease, therefore the perinatal outcomes are diverse from each other. When complicating with other disease, maternal cardiac function has already changed during the first trimester. Maternal cardiac function of multiple pregnancies is related to the pregnancy outcomes.