В статье проведен сравнительный анализ основных параметров гемодинамики и особенностей ее ауторегуляции при физиологически протекающей беременности и беременности на фоне гипертензивных расстройств.
Проведено обследование 196 пациенток в III триместре беременности (65 – с физиологически протекающей беременностью, 66 – с хронической артериальной гипертензией и 65 – с беременностью, осложнившейся преэклампсией) с помощью неинвазивной биоимпедансной технологии с расчетом колебательной активности и спектральным анализом параметров ритма сердца, артериального давления среднего и ударного объема.
Получены достоверные отличия показателей гемодинамики во всех исследованных группах, наиболее выраженные отклонения отмечены при беременности, осложненной преэклампсией. Наличие хронической артериальной гипертензии у беременных сопровождается напряжением адаптивных реакций вегетативной нервной системы. В группе тяжелой преэклампсии наряду с напряжением регуляции артериального давления отмечалось угнетение (истощение) адаптивных механизмов регуляции сердечного ритма. Это требует дифференцированного подхода к выбору терапии и метода анестезиологической защиты при абдоминальном родоразрешении.
In the article the comparative analysis parametres of haemodynamics and features of autoregulation of haemodynamics in patients with uncomplicated pregnancy and pregnancy with hypertension is carried out.
Complex investigation of central haemodynamics in 196 patients in the third trimester of pregnancy (65 – with physiologically proceeding pregnancy, 66 – with chronic arterial hypertensia, 65 patients with the pregnancy complicated by preeclampsia) by means of noninvasive bioimpedance technology with calculation of oscillatory activity and the spectral analysis of the three parametres of haemodynamics was carried.
Authentic differences of parameters of central haemodynamics and the data of the spectral analysis between healthy pregnant women and pregnant women with hypertensive the disorders were received, the most expressed deviations are noted in preeclampsia.
Considering compromised haemodynamics regulation in patients with preeclampsia the differentiated approach to therapy and choice of anesthesiological protection is required at operative delivery in this group of pregnant women.
Key words: pregnancy, autoregulation of hemodynamics, the spectral analysis, chronic arterial hypertension, preeclampsia.
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1. Makarov O.V., Tkacheva O.N., Volkova E.V. Preeklampsiia i khronicheskaia arterial'naia gipertenziia. Klinicheskie aspekty. M.: GEOTAR-Media, 2010. [in Russian]
2. Moertl MG, Ulrich D, Pickel KI et al. Changes in haemodynamic and autonomous nervous system parameters measured non-invasively throughout normal pregnancy. Eur J Obstet Gynecol Reprod Biol 2009; 144 (Suppl. 1): S179–83.
3. Mittal BV, Singh AK. Hypertension in the developing world: challenges and opportunities. Rev Am J Kidney Dis 2010; 55 (3): 590–8.
4. WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. Geneva: World Health Organization, 2011.
5. Abalos E, Cuesta C, Carroli G et al. Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization multicountry survey on maternal and newborn health. BJOG 2014; 121 (Suppl. 1): 14–24.
6. Lindheimer MD, Taler SJ, Cunningham FG. Hypertension in pregnancy. J Am Soc Hypertens 2010; 4 (2): 68–78.
7. Fatkullina I.B. Osobennosti vegetativnoi reguliatsii serdechnogo ritma u beremennykh s preeklampsiei raznykh etnicheskikh grupp. Fundamental'nye issledovaniia. 2011; 5: 180–4. [in Russian]
8. Rad'kov O.V., Il'inskaia T.A., Blinova N.I. Gestatsionnaia dinamika pokazatelei variabel'nosti ritma serdtsa u beremennykh s khronicheskoi arterial'noi gipertenziei. Kardiologiia v Belarusi. 2011; 5: 306. [in Russian]
9. Pal GK, Shyma P, Habeebullah S et al. Spectral analysis of heart rate variability for early prediction of pregnancy-induced hypertension. Clin Exp Hypertens 2009; 31 (4): 330–41.
10. Diagnostika i lechenie serdechno-sosudistykh zabolevanii pri beremennosti. Natsional'nye rekomendatsii. M.: Vserossiiskoe nauchnoe obshchestvo kardiologov; 2010. [in Russian]
11. Astakhov A.A., Astakhov-ml A.A. Kontseptsiia krovoobrashcheniia dlia anesteziologa i reanimatologa: monografiia. Cheliabinsk: Izd-vo IuUGMU, 2014. [in Russian]
12. Fleishman A.N. Variabel'nost' ritma serdtsa i medlennye kolebaniia gemodinamiki: nelineinye fenomeny v klinicheskoi praktike. Novosibirsk: ID SO RAN; 2009. [in Russian]
13. Heart Rate Variability. Standards of measurement, physiological interpretation, and clinical use. Task force of the european society of cardiology and the North American Society of pacing and electrophysiology. Eur Heart J 1996; 17 (3): 354–81.
14. Mazzeo AT, La Monaca E, Di Leo R et al. Heart rate variability: a diagnostic and prognostic tool in anesthesia and intensive care. Acta Anaesthesiol Scand 2011; 55 (7): 797–811.
15. Tejera E, Areias MJ, Rodrigues AI et al. Relationship between heart rate variability indexes and common biochemical markers in normal and hypertensive third trimester pregnancy. Hypertens Pregnancy 2012; 31 (1): 59–69.
16. Hypertension in pregnancy. Report of the American College of obstetricians and gynecologists’ task force on hypertension in pregnancy. American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122 (5): 1122–31.
17. Hypertension in pregnancy: the management of hypertensive disorders during pregnancy. NICE Clinical Guidelines, No. 107. National Collaborating Centre for Women's and Children's Health (UK). London: RCOG Press; 2010.
18. Lowe SA, Bowyer L, Lust K et al. The Management of Hypertensive Disorders of Pregnancy. The recommendations of the Society of Obstetric Medicine of Australia and New Zealand. SOMANZ; 2014.
19. Chazova I.E., Ratova L.G. i dr. Diagnostika i lechenie arterial'noi gipertenzii (rekomendatsii Rossiiskogo meditsinskogo obshchestva po arterial'noi gipertonii i Vserossiiskogo nauchnogo obshchestva kardiologov). Sistemic Hypertension. 2010; 3: 5–26. [in Russian]
20. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31 (7): 1281–357.
Авторы
Р.А.Макаров*1, С.В.Кинжалова1, Н.С.Давыдова2
1 ФГБУ Уральский научно-исследовательский институт охраны материнства и младенчества Минздрава России. 620028, Россия, Екатеринбург, ул. Репина, д. 1;
2 ГБОУ ВПО Уральский государственный медицинский университет Минздрава России. 620028, Россия, Екатеринбург, ул. Репина, д. 3
*r_makarov_ekb@mail.ru
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R.A.Makarov*1, S.V.Kinzhalova1, N.S.Davydova2
1 Mother and Child Research Institute. 620028, Russian Federation, Ekaterinburg, ul. Repina, d. 1;
2 Ural State Medical University. 620028, Russian Federation, Ekaterinburg, ul. Repina, d. 3
*r_makarov_ekb@mail.ru