Електролітні зрушення у вагітних з раннім гестозом

Abstract

В статті наведено сучасні міркування щодо електролітного балансу під час вагітності та його змін при ранньому гестозі. Розглянуто вплив раннього гестозу на працездатність та якість життя жінки. Продемонстровано концентрацію основних електролітів в сироватці в першому та другому триместрах залежно від наявності блювання як клінічного симптому раннього гестозу. Показано, що багатократне блювання до 12 тижнів вагітності не чинить істотного впливу на концентрацію основних електролітів в сироватці, але виявлено відмінності в тенденції до зміни цих показників в процесі прогресування вагітності. На тлі раннього гестозу виявлено відносне зменшення вмісту натрію в сироватці до 20-22 тижнів, без гестозу – зростання цього показника. Наведені результати, що свідчать про надчутливу регуляцію електролітного обміну, використано як аргумент проти неконтрольованого призначення інфузійної терапії для корекції симптомів раннього гестозу; В статье приведены современные рассуждения об электролитном балансе во время беременности и его изменениях при раннем гестозе. Рассмотрено влияние раннего гестоза на работоспособность и качество жизни женщины. Продемонстрировано концентрацию основных электролитов в сыворотке в первом и втором триместрах в зависимости от наличия рвоты как клинического симптома раннего гестоза. Показано, что многократная рвота до 12 недель беременности не оказывает существенного влияния на концентрацию основных электролитов в сыворотке, но выявлены различия в тенденции к изменению этих показателей в процессе прогрессирования беременности. На фоне раннего гестоза выявлено относительное уменьшение содержания натрия в сыворотке до 20-22 недель, без гестоза – рост этого показателя. Приведенные результаты, свидетельствующие о сверхчувствительной регуляции электролитного обмена, использованы как аргумент против неконтролируемого назначения инфузионной терапии для коррекции симптомов раннего гестоза; The problem of vomiting in early pregnancy has a long history, numerous arguments as to the origin, treatment and consequences of pregnancy and so on. Despite significant differences in the statistical data, researchers concluded that on average 50% pregnant have varying degrees of severity of this symptom. Heavy (excessive) vomiting, instead, complicates under 3 0.3% of all pregnancies. According to modern definition of excessive vomiting, it is a condition that is accompanied by a loss of 5% or more of body weight, dehydration and electrolyte disorders. Over the past 30 years, the etiology of nausea and vomiting in early pregnancy has been the subject of various studies, none of which clearly did not confirm either functional or organic nature of the disease, alone or together. One of the main questions of taking care by vomiting in early pregnancy, except for number of episodes of vomiting during the day, is the presence and severity of electrolyte imbalance, which should be the result of nutritional inadequacy due to refuse of food and loss of electrolytes by vomiting, increasing blood concentration. In addition, the important issue is the continuing transformation of electrolyte balance with the progression of pregnancy and their impact on the incidence of gestational complications. The goal of the study was to learn concentration of main electrolytes in pregnant women with vomiting in the first and second trimester. The study involved 109 pregnant women with terms 10-12 weeks, who were divided in two groups. The first group included 58 pregnant women, who during the first trimester of pregnancy have noted varying degrees of severity – from 3 to 10 times a day. Patients of the first group was recommended non-medication (correction of diet and diet) and drug methods of influence on early morning sickness (medicines containing ginger extract, vitamins). The second group included 51 pregnant women who had neither nousea nor vomiting during first weeks of pregnancy. All pregnant women were identified concentrations of sodium, potassium, calcium, carbonate ion in serum. The first study was performed at 10-12 weeks, a second – in 20-22 weeks. Results and discussion. Pregnancy is a period of changes in the regulation of all metabolism types, the primary purpose of those is to preserve maternal homeostasis against the backdrop of tensions limit the functioning of metabolism and energy expenditure in the construction of additional vascular bed. One of the first of these changes deals with electrolytes – from the very beginning of 5th week. However limits this restructuring is extremely narrow – at pregnant women in both groups the average values of the concentration of electrolytes were determined in the normal, typical non-pregnant wom. This is easily explained, because proper functioning of cell membranes, and therefore – the viability of the whole organism depends on electrolyte homeostasis. Despite the lack of statistical probability of changes in the concentration of sodium in the dynamics between groups can be traced multidirectional trends. Thus, the first group have a tendency to increase this concentration till 20-22 weeks, a group of pregnant women who had vomiting, demonstrated of this indicator. In addition, the important issue is the relationship electrolyte fluctuations of the delicate process of protein metabolism. As the high molecular weight compounds, including proteins, constitute a significant part of total plasma (6-7%), and in contrast to the electrolytes that are charged electrically neutral, they are replacing electrolytes from the plasma volume that busy non-electrolytes. Extremely thin electrolyte regulation makes it inappropriate and even dangerous uncontrolled environments purpose infusion for the treatment of patients with vomiting in early pregnancy.