1、 要点提示妊娠期高血压疾病的临床分型、各型的临床表现及处理原则。The clinical classification, manifestation,and the treatment principles of different hypertension states of pregnancy.硫酸镁治疗妊娠期高血压疾病的用药方法及观察要点。The usage and observation of the magnesium sulfate. http:/www.health.am/pregnancy/hypertensive-states-of-pregnancy/http:/www.a
2、afp.org/afp/2008/0701/p93.html第四节 妊娠期高血压疾病Hypertensive States of Pregnancy妊娠期高血压疾病(hypertensive states of pregnancy)包括：妊娠期高血压(gestational hypertension)子痫前期(preeclampsia)子痫(eclampsia)慢性高血压并发子痫前期( chronic hypertension with superimposed preeclampsia)妊娠合并慢性高血压(chronic hypertension complicating pregnancy
3、)本病以高血压、蛋白尿、水肿为主要症状，可伴有全身多器官功能损害或衰竭，重者可出现抽搐、昏迷甚至死亡，严重危害母婴健康，是孕产妇及围生儿死亡的主要原因。hypertensive states of pregnancy：The main symptoms are hypertension, proteinuria, edema, accompanied by multiple organ disfunction or failure, seriously to be possible to have twitches, the stupor even maternal infant to die
4、.http:/www.health.am/pregnancy/hypertensive-states-of-pregnancy/【高危因素 Risk factors 】精神过度紧张；寒冷季节或气压升高时；年轻初产妇 或高 初产妇 ；有慢性高血压、 、 尿病病 的孕妇； 者或者 者；状 ；子 张 过高者， 、水过多；有高血压病 ；the spiritual hypertension；in the cold reasons or increased barometric pressure；nulliparity，maternal age below 20 or over 35；Past histo
5、ry of D.M, Hypertension and Renal diseases；malnutrition；Obesity；low socioeconomic statusMultiple gestation, polyhydramnios；Family history of hypertension；【病因pathogenesis】可能currency1“ fi子 fl 、血 损、”因素、 、 素 有。pathogenesis: Some theories include (1) endothelial cell injury, (2) rejection phenomenon (ins
6、ufficient production of blocking antibodies), (3) compromised placental perfusion, (4) altered vascular reactivity, (5) imbalance between prostacyclin and thromboxane, (6) decreased glomerular filtration rate with retention of salt and water, (7) decreased intravascular volume, (8) increased central
7、 nervous system irritability, (9) disseminated intravascular coagulation, (10) uterine muscle stretch (ischemia), (11) dietary factors, and (12) genetic factors. 【病理生理】 全身全身小动脉痉挛管腔狭窄，外周阻力增加血压升高肾小动脉痉挛，血流量减少,肾缺血缺氧肾小球通透性增加血浆蛋白漏出蛋白尿肾小球滤过率降低水肿血浆胶体渗透压降低激活RAA系统胎盘脑 心脏肝脏激活RAS系统【pathophysiology】 systemic arte
8、riole spasmsystemic arteriole spasmangiostenosis，Increased peripheral resistancehypertensionrenal arteriole spasm，decreased glomerular perfusion, hypoxia-ischemiaincreased permeability of glomerular,plasma protein leakageproteinuriadecreased glomerular filtration rateedemadecreased plasma colloid os
9、moticpressureactivation of renin angiotensinaldosterone system placentabrain cardiovascularliverrenin-angiotensinsystem临床表现及分 manifestation and calssification 妊娠期高血压 妊娠期 出现，并 产 ；尿蛋白 ；可伴有 或血 ，产 方可 。 Gestational hypertension or pregnancy-induced hypertension (PIH) is defined as the development of new
10、arterial hypertension in a pregnant woman after 20 weeks gestation without the presence of protein in the urine. Gestational hypertension is further divided into transient hypertension of pregnancy if preeclampsia is present at the time of delivery and the blood pressure is normal by 12 weeks postpa
11、rtum, and chronic hypertension if the elevation in blood pressure persists beyond 12 weeks postpartum. 轻度： ，孕 以 出现；尿蛋白 或 。可伴有 、 、 症状。 Preeclampsia is hypertension associated with proteinuria and edema, occurring primarily in nulliparas after the 20th gestational week and most frequently near term. T
12、here are 2 categories of preeclampsia, mild and severe. mild preeclampsia is defined as the following: (1) HTN ( ); (2) proteinuria exceeding 0.3 g in a 24-hour period or 1-2+ on dipstick testing;(3) Edema (hands or/and face) without other signs/symptoms 子痫前期 preeclampsia 重度： ；尿蛋白 或 ；血fl ；血 ；血 病性血 血
13、 升高 ；血 或 S 升高；持续性 或其它脑神 或觉障碍；持续性 。 Severe preeclampsia is defined as the following: (1) blood pressure greater than 160 mm Hg systolic or 110 mm Hg diastolic on 2 occasions 6 hours apart; (2) proteinuria exceeding 2 g in a 24-hour period or 2-4+ on dipstick testing; (3) increased serum creatinine ( 1.2 mg/dL unless known to be elevated previously); (4) oliguria 500 mL/24 h; (5) cerebral or visual disturbances; (6) epigastric pain; (7) elevated liver enzymes; (8) thrombocytopenia (platelet count 100,000/mm3); (9) retinal hemorrhages, exudates, or papilledema; and (10) pulmonary edema. 子痫前期
