妊娠期高血压与心电图异常的交互作用对妊娠不良结局的影响

The interactive effect of gestational hypertension and electrocardiographic abnormalities on adverse pregnancy outcomes

    摘要
  • 摘要:
    目的  探讨妊娠期高血压与心电图异常的交互作用对妊娠不良结局的影响。
    方法  选取2015年1月至2023年1月在武汉市第四医院妇产科进行孕期登记、规范产前检查并完成分娩的妊娠期高血压患者240例为妊娠期高血压组，同期选取血压正常、无妊娠期并发症的健康孕妇240例作为正常血压组。收集两组孕妇的血压、心电图参数及相关临床资料进行比较。采用逐步logistic回归分析妊娠不良结局的影响因素，以及妊娠期高血压和心电图异常的交互作用对妊娠不良结局的影响。
    结果 正常血压组心电图异常41例，正常199例；妊娠期高血压组心电图异常122例，正常118例。与正常血压组比较，妊娠期高血压组24 h平均血压、24 h平均动脉压变异系数、QT间期、QTc间期和P波宽度较高（均P＜0.05），而心率和QRS波群宽度较低。妊娠期高血压组窦性心动过速、ST-T段改变、房性早搏、室性早搏及窦性心动过缓发生率明显高于正常血压组（均P＜0.05）。妊娠期高血压组中，心电图异常患者的产后出血、早产、大于胎龄儿、小于胎龄儿、巨大儿以及不良妊娠结局总发生率（49.18%比26.83%、11.56%、19.49%）最高（P＜0.05）。多因素logistic回归分析结果显示，ST-T段改变（OR =1.742, 95%CI: 1.193～2.543）、24 h平均收缩压（OR =1.808, 95%CI: 1.214～2.691）、24 h平均舒张压（OR =1.861, 95%CI:1.172～2.955）、24 h平均动脉压变异系数（OR =1.377, 95%CI: 1.038～1.826）、QT间期（OR =1.904, 95 %CI: 1.538～2.358）和QTc间期（OR =2.184, 95 %CI: 1.467～3.251）是妊娠不良结局的影响因素（均P＜0.05）。交互作用结果显示，同时存在心电图异常和妊娠期高血压是妊娠不良结局的风险因素（OR=2.716，95%CI: 2.008～3.672，P＜0.05）。
    结论 妊娠期高血压与心电图异常交互作用对妊娠不良结局产生影响。

     

    Abstract:
    Objective To explore the interactive effect of gestational hypertension and electrocardiographic abnormalities on adverse pregnancy outcomes.
    Methods A total of 240 pregnant women with gestational hypertension who registered for prenatal care, received standardized antenatal examinations, and completed delivery in the Department of Obstetrics and Gynecology of Wuhan No.4 Hospital from January 2015 to January 2023 were selected as the gestational hypertension group. During the same period, 240 healthy pregnant women with normal blood pressure and no gestational complications were selected as the normal blood pressure group. Blood pressure, electrocardiographic parameters, and related clinical data of the two groups were collected and compared. Stepwise logistic regression analysis was used to identify the influencing factors of adverse pregnancy outcomes and the interactive effect of gestational hypertension and electrocardiographic abnormalities on adverse pregnancy outcomes.
    Results In the normal blood pressure group, 41 cases had electrocardiographic abnormalities and 199 cases were normal; in the gestational hypertension group, 122 cases had electrocardiographic abnormalities and 118 cases were normal. Compared with the normal blood pressure group, the gestational hypertension group had significantly higher 24-hour average blood pressure, 24-hour average arterial pressure variability coefficient, QT interval, QTc interval, and P-wave width (all P＜0.05), while the heart rate and QRS complex width were lower. The incidences of sinus tachycardia, ST-T segment changes, atrial premature beats, ventricular premature beats, and sinus bradycardia in the gestational hypertension group were significantly higher than those in the normal blood pressure group (all P＜0.05). Among the gestational hypertension group, patients with electrocardiographic abnormalities had the highest incidences of postpartum hemorrhage, preterm birth, large for gestational age infants, small for gestational age infants, macrosomia, and total adverse pregnancy outcomes (49.18% vs. 26.83%, 11.56%, 19.49%) (P＜0.05). Multivariate logistic regression analysis showed that ST-T segment changes (OR=1.742, 95%CI: 1.193 to 2.543), 24-hour average systolic blood pressure (OR=1.808, 95%CI: 1.214 to 2.691), 24-hour average diastolic blood pressure (OR=1.861, 95%CI:1.172 to 2.955), 24-hour average arterial pressure variability coefficient (OR=1.377, 95%CI: 1.038 to 1.826), QT interval (OR=1.904, 95%CI: 1.538 to 2.358), and QTc interval (OR=2.184, 95%CI: 1.467 to 3.251) were influencing factors of adverse pregnancy outcomes (all P＜0.05). The results of interaction analysis showed that the coexistence of electrocardiographic abnormalities and gestational hypertension was a risk factor for adverse pregnancy outcomes (OR=2.716, 95%CI: 2.008 to 3.672, P＜0.05).
    Conclusion The interaction between gestational hypertension and electrocardiographic abnormalities has an impact on adverse pregnancy outcomes.

     

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