指尖容積脈波による妊娠中毒症発症の予知に関する研究

抄録

In toxemia of pregnancy in late stage, principal lesions occur in the vasorenal system: increased vasoconstrictive response to pressors during pregnancy is considered to be involved in the manifestations of toxemia of pregnancy, such as hypertension. In a total of 165 patients including normal women pregnant for 28 weeks or more, pregnant women suffering from toxemia of pregnancy and puerpera either normal or with persisting toxemic symptoms, the author has made an analysis of plethysmographic findings obtained during Aschner's eyeball pressure test, the cold pressor test or noradrenalin tolerance test to determine whether or not it is possible to predict the onset and prognosis of toxemia of pregnancy.
1) Among patients already suffring from toxemia of pregnancy, there was a high incidence of positive cold pressor test. Noradrenaline test proved to be more useful in forboding the development of toxemia of pregnancy, which actually occurred in 66.7% of positive cases subsequently.
2) Abnormal sphygmoplethysmographic patterns were observed in 73.9% of pregnant women suffering from toxemia of pregnancy. Toxemia of moderate or higher severity developed later in 44.5% of normal pregnant women with abnormal sphygmoplethysmographic patterns. Such patterns associated with tolerance tests, however, were of significantly high incidence only in the group of patients with toxemia of pregnancy, and hence not useful enough in foretelling the pathogenesis of the disease.
3) An analysis of sphygmoplethysmographic patterns revealed no significant difference between normal pregnant women with edema of mild severity developing subsequently and those remaining normal throughout the trial. In normal pregnant women presenting with proteinuria and hypertension in the subsequent course, there was an increase in increment index along with a decrease in conduction time of pulse wave, a tendency observed more markedly during tolerance tests. Thus, increased peripheral resistance preceded the manifestation of symptoms in pretoxemic pregnant women.
4) In case of preexisting toxemia of pregnancy with gradually aggravating symptoms, there was an increase in increment, decrement and dicrotic indices together with a decrease ni ejection time index and conduction time of pulse wave. This implies that the risk of toxemia may be greater in the case of peripheral resistance tending to increase more sharply. It may be concluded from these results that moderate or severe toxemia will be of higher incidence among patients presenting with positive noradrenalin test, abnormal sphygmoplethysmographic patterns, increased increment index or reduced conduction time of pulse wave and especially among those in whom such a tendency is more accentuated in the cold pressor or noradrenalin test, and that toxemia of pregnancy is more likely to be aggravated in patients already suffering from the condition in whom the indices tend to decline, and more markedly in the cold pressor test.