DYNAMICS OF VENOUS PRESSURE AT TOXICOSES OF PREGNANT WOMEN
" Toxicoses of pregnancy ". The collection of clauses under ΡΠ΅Π΄. And. Item of Nikolaev
From faculty of obstetrics and gynecology of the Leningrad state medical institute.
M. of Century of Zhuravlyov
Fluctuations of venous pressure considered as consequence of a passive extensibility of veins, but now experiences on the isolated vessels earlier is proved, that a mechanical extensibility venous less arterial.
The venous vascular network is much more extensive arterial, veins comprise three times, it is four times more than blood, than an artery, and the device regulation is necessary for preservation of size of a blood channel in the widest department of vascular system - in a venous network.
The active role of a venous tone for blood circulation long did not admit. Now the doctrine about a venous tone has received correct illumination from positions Pavlovsk Hypertension symptoms.
and others it is established, that fluctuations of venous pressure depend on functional changes of heart and a vascular tone, in particular venous and, in connection with various influences, first of all from nervous system. finds out sensitive reactance of a venous tone on emotions and painful irritations. Hypertension symptoms
The question on a tone of venous vessels represents doubtless interest and concerning the period of pregnancy at normal and its pathological current, especially at late toxicoses pregnancy. As is known, to a question on reaction of arteries, Π±Π£Π€Π΅ΡΠΈΠΎΠ» and about an arterial blood pressure at toxicoses of pregnant women in the literature a lot of attention is given; As if to a venous tone at normal and pathologically proceeding pregnancy this question till now remains very little studied. And meanwhile, besides stated above reasons about dependence of a venous tone on influence of cleanly nervous factors, there are also other instructions, allowing to consider the given question and theoretically, and practically important concerning late toxicoses of pregnant women. So, some authors specify, that infringements of a tone of venous vessels occur at various intoxications. Hypertension symptoms writes: « All diseases which entail distortions of a metabolism or detain allocation them, cause characteristic for hypostases of infringement of a feed of a vascular wall ». Observed at late toxicoses Π°ΡΠΈΠ΄ΠΎΠ· also breaks a tone of venous vessels aside their increases as continuously increases loading of the cardiovascular device.
In the literature also there are instructions that venous pressure at some pregnant women with a late toxicosis is raised (above 120 mm of a water column) (Hypertension symptoms). Venous pressure is raised mostly at those forms of toxicoses at which the expressed increase of arterial pressure is combined with significant hypostases and intimate insufficiency. Increase of venous pressure is an attribute of hard proceeding process and usually goes in parallel with increase of intracranial pressure and heavy defeats of an eye bottom. On value of parameters of venous pressure is underlined as well in work; in particular, in it it is marked, that in some cases increase of venous pressure at can testify about coming nearer even if there is no increase of arterial pressure. Low parameters of venous pressure at various intoxications testify to sharp damage of a vascular tone, about a toxic hypotonia.
We have set for ourselves a problem to study dynamics of venous pressure at normal and pathological pregnancy. In the present research we submit data, concerning mainly pregnant, suffering toxicoses.
For measurement of venous pressure we used designs both the technique developed by it and offered for clinical researches.
consists of a glass capillary with a gleam in 1 mm. The linear scale in millimeters from 0 up to 350 is put directly on a wall of a tube. The bottom end of a tube is narrowed for connection with a rubber tubule in length of 40 sm which terminates in a needle. The top end of a capillary also is narrowed for connection with a rubber cylinder by means of which the capillary Hypertension symptoms with water or up to a designation - zero is filled. After blood acts in the device, lifting a column of a liquid in a manometer up to the height equal to intravenous pressure. The size of venous pressure is defined in millimeters of a water column.
This method of measurement of venous pressure reflects the fluctuations of venous pressure occuring in an organism first of all under influence of nervous system more precisely. Change of the position, the forced breath, muscular work is reflected in height of venous pressure, mental excitation and so forth Therefore the patient necessarily warned of forthcoming manipulation.
If the patient had a free time it was offered to lie down easy minutes 10-20.
Inspection is made in position on a back with the allocated top finiteness. Filled by a liquid up to 0 manometrical tube we put near to themselves, Hypertension symptoms a vein and it is waited 1/2-1 minute, that pressure in a vein Π²ΡΡΠΎΠ²Π½ΠΈΠ»ΠΎΡΡ. We take in the left hand a glass tube and it is held it vertically at a level of the bottom edge of a chest muscle, at poles of the patient. This point (a point of zero) corresponds approximately to height of the right auricle. Blood acts in a tube, lifting a column of a liquid in a manometer. The received figure it is checked on stability, offering surveyed either to hold the breath, or to force an exhalation then the risen venous pressure again comes back to an initial level. Strictly observing the specified technics of research, we had no an initial phase of long venous rise with slow descent, any casual fluctuations - received results were natural.
Offered the method is safe for the patient as nothing is entered into blood; the device also is easily disinfected.
We study dynamics of venous pressure at 310 women from whom there were 120 healthy pregnant women with different terms of pregnancy, 89 women, suffering by various toxicoses of pregnancy, and 101 . Research was spent in most cases at the same women to the different periods of pregnancy, sorts and the postnatal period. The arterial blood pressure was in parallel measured, pulse was defined, the general careful inspection of pregnant women was made. We pass to the analysis of our data on separate groups.
Healthy pregnant women.
Apparently from tab., at normal pregnancy venous pressure is mostly within the limits of, coming nearer to the top border of norm (if to accept for norm venous pressure of a water column of 70-100 mm at not pregnant women), and some tendency to shift aside higher parameters of venous pressure, as approaching the end of pregnancy is marked. So, if venous pressure above 100 mm of a water column was observed only at 16,7 % of all surveyed in first half of pregnancy of women in second half of pregnancy it was observed at 28,4 % from them.
We consider necessary to note, that on venous pressure we could not catch special influence of age, quantity of preceded sorts.
Parameters of venous pressure at healthy women in sorts in the period of disclosing are at the majority of them in norm or on the top border of norm, and in the period of exile noticeably raise. After sorts venous pressure at these women quickly comes to norm.
Early toxicoses of pregnant women. We observed clinical displays of early toxicoses in the form of the unrestrained vomiting pregnant women accompanied mostly as well plentiful Hypertension symptoms.
Under our supervision there were 14 patients in the age of 22-33 years with heavy and average weight forms of disease. Term of pregnancy at them was 6-14 weeks. was six, eight, given birth-six, had abortion in occasion of unrestrained vomiting - one.
Venous pressure was measured at receipt and repeatedly during treatment. Patients were in clinic from 8 till 35 days. At 14 patients 50 researches of venous pressure are lead. The lowest pressure was 45 mm, the highest-115 mm of a water column. Small fluctuations aside increases of a tone of venous system are marked at recover, at improvement of the general condition of the patient. A greater part of patients therapy, 5 patients - therapy by a medicamentous dream (0,2-0,3 on 3 times day within 4-9 days was made bromine-; patients slept from 18 till 20 o'clock in day). At application bromine- of therapy in process of improvement of a condition of the patient small increase of venous pressure was observed, parameters, however, did not fall outside the limits norm. During a dream venous pressure also changed a little and remains in former borders. At 2 patients, suffered especially heavy toxicosis at which it was necessary to interrupt pregnancy owing to an inefficiency of therapy, observed a venous hypotonia (45-52 mm of a water column), the arterial blood pressure was 90/55-100/60.
Thus, venous pressure at early toxicoses of average weight did not fall outside the limits average sizes. At heavy forms the venous hypotonia was observed.
Late toxicoses of pregnant women.
In total we had been surveyed 75 pregnant women with the phenomena of a late toxicosis of type. At a three has ended, at a four exclusively heavy form of a toxicosis owing to what it was required
At 55 of 75 patients we observed increase pressure from 135 up to 240 mm and from 85 up to 140 mm.
At repeated researches of venous pressure at Hypertension symptoms we could establish, that before treatment and Ρ it at 51 % of pregnant women was raised, at 31 %-high and only at 18 % was on the top border of norm. In sorts at these women venous pressure was raised in an even greater degree (at 66 %). After sorts venous pressure came back to norm much more slowly, than at healthy Hypertension symptoms: so, at half of all surveyed for the second day after sorts venous pressure remains still raised and regarding cases even high while arterial pressure came nearer to norm. Between an arterial and venous blood pressure we observed the same absence of parallelism at group of patients with late toxicoses at which arterial pressure was normal. Such pregnant women was 10 and at 6 of them venous pressure was raised and high.
We would like to note that fact, that at 3 pregnant women with ΡΠΊΠ»Π°ΠΌΠΏΡΠΈΠ΅ΠΉ after a rate Hypertension symptoms therapies arterial pressure has considerably decreased, while the venous hypertension remained a rack (205-260 mm of a water column) and was as though a signal of trouble. At in sorts venous pressure decreased to norm in the first days after sorts. At postnatal ΡΠΊΠ»Π°ΠΌΠΏΡΠΈΠΈ the venous hypertension decreased after vigorous Hypertension symptoms therapies only to 12-ΠΌΡ to day after sorts. At a part of patients we managed to reveal influence magnesias and a dream on fluctuation of venous pressure at. It has appeared, that as a result of treatment almost at 70 % of the surveyed pregnant women the raised and high venous pressure reduced an axis to norm.
Thus, our supervision above pregnant women with the phenomena Hypertension symptoms have shown, that at this toxicosis venous pressure noticeably raises, especially at; after sorts venous pressure is more slowly leveled, than arterial, and that strict parallelism between arterial and venous pressure at is not present. Probably, that at some pregnant women venous pressure can have more certain Hypertension symptoms value, than arterial.
1. Venous pressure both in the first, and in second half of the pregnancy normally proceeding, remains, as a rule, within the limits of norm or the top border of norm, and in second half of pregnancy parameters tend to shift aside higher figures.
2. Venous pressure noticeably raises in sorts, especially in the period of exile, and after sorts quickly goes down.
3. At early toxicoses of average weight venous pressure changes a little, at heavy - there is an expressed hypotonia.
4. At late toxicoses venous pressure is noticeably raised, especially at.
5. Arterial and venous pressure not Π²Π΅Π³Π΄Π° coincide. Discrepancy of venous and arterial pressure can have value, that we observed at pregnant women with ΡΠΊΠ»Π°ΠΌΠΏΡΠΈΠ΅ΠΉ. Venous pressure is valuable additional diagnostic a method of inspection of pregnant women, especially at late toxicoses.
6. The question on dynamics of venous pressure at normal and pathologically proceeding pregnancy deserves the further studying, mainly in view of typological features of nervous system of pregnant women.
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