摘要
目的:观察妊娠合并肺动脉高压患者(PAH)接受剖宫产围术期性激素水平的变化规律,并分析与血流动力学变化的相关性及麻醉科的有效干预治疗。方法:选择北京安贞医院妊娠合并PAH接受剖宫产手术患者,根据入室放置Swan-Ganz导管测得的肺动脉压力数值,分为中度组(SPAP:50~79mm Hg,1mm Hg=0.133k Pa)和重度组(SPAP>80mm Hg),并于术前、术毕、术后24h、术后48h及术后72h抽取静脉血,检测血浆性激素-总睾酮(TT)、雌二醇(E2)、促黄体生成激素(LH)、促卵泡激素(FSH)、孕激素(PROG)、催乳素(PRL)及人绒毛膜促性腺激素(HCG)水平,同时记录各时点血流动力学参数及血管活性药应用情况。结果:中度组和重度组各15例,经过组内和组间对比发现,两组患者术后各时点的E2、HCG、TT水平均较术前有明显下降趋势,重度组E2、TT下降幅度更为显著,差异具有统计学意义(P<0.05),两组患者术后各时点的FSH、LH、PROG水平均较术前有升高趋势,但差异不具有统计学意义(P>0.05);两组患者收缩压、舒张压以及平均压除术毕高于术前,但差异无统计学意义(P>0.05),两组收缩压和平均压术后48h和72h均较术毕下降明显,差异具有统计学意义(P<0.05)。重度组各时点的收缩压低于中度组,但两组差异无统计学意义(P>0.05),组间比较重度组平均压术后24h较中度组下降明显,差异具有统计学意义(P<0.05)。分析组别、性激素变化等因素对动脉压力的影响发现,性激素含量对平均动脉压无显著影响,差异无统计学意义(P>0.05)。结论:妊娠合并PAH患者剖宫产围术期性激素水平变化具有一定规律性,娩出胎儿后性激素E2和TT下降,围术期血管活性药的合理应用是稳定血流动力学的关键。
Objective ：The purpose of this study was to observe the changes of sex hormones concentra- tions in plasma for pregnants with pulmonary arterial hypertension （PAH） during cesarean section and analysis the correlation between the level of hormonal and hemodynamic parameters. Methods： We selected pregnant women with PAH who underwent cesarean section in Anzhen Hospital , all the pregnants were divided into two groups according to the degree of pulmonary hypertension by Swan-Ganz ： a moderate group and a severe group. Mso, the venous blood before operation, 24 hours ,48 hours and 72 hours after operation were collected to measure the plasma sex hormone concentrations by electrochemiluminescence and ELISA , and the hemodynamic parameters and the dosage of vasoactive drugs were recorded. Results：There were 15 cases in moderate group and severe group respectively. The levels of E2, HCG and TI＂ in the two groups after operation were significantly lower than that before operation after contrasting intra-group and inter-group, and The decrease was more signif- icant of E2 and TT in the severe group （P 〈 0. 05 ）, the levels of FSH, LH and PROG after operation in the two groups were higher than that before operation, but the difference had no significant （ P 〉 0. 05 ）. The systolic blood pressure （ SBP）, and mean arterial blood pressure （MAP） of the two groups at 48h and 72h after opera- tion were lower significantly than the value at the end of operation （P 〈 0.05）. The SBP of the severe group at each time point were lower than that in moderate group, but had no significant （ P 〉 0. 05 ）, the MAP of 24 hour after operation in severe group was lower statistically than the moderate group at the same time point （ P 〈 0. 05 ）. The dosage of vasoactive drugs in severe group were larger than that in moderate group statistically （ P 〈 0. O1 ）. Also,we found that the sex hormone levels had no significant effects on mean arterial pressure. Conclu- sion： The hormone concent
出处
《心肺血管病杂志》
2017年第2期114-118,共5页
Journal of Cardiovascular and Pulmonary Diseases
基金
基金项目: 首都临床特色应用研究与成果推广( Z151100004015022)
