妊娠期期高血压疾病 中英版

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。Theclinicalclassification,manifestation,andthetreatmentprinciplesofdifferenthypertensionstatesofpregnancy.硫酸镁治疗妊娠期高血压疾病的用药方法及观察要点。Theusageandobservationofthemagnesiumsulfate.://第四节妊娠期高血压疾病HypertensiveStatesofPregnancy妊娠期高血压疾病(hypertensivestatesofpregnancy)包括：①妊娠期高血压(gestationalhypertension)②子痫前期(preeclampsia)③子痫(eclampsia)④慢性高血压并发子痫前期(chronichypertensionwithsuperimposedpreeclampsia)⑤妊娠合并慢性高血压(chronichypertensioncomplicatingpregnancy)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。hypertensivestatesofpregnancy：Themainsymptomsarehypertension,proteinuria,edema,accompaniedbymultipleorgandisfunctionorfailure,seriouslytobepossibletohavetwitches,thestuporevenmaternalinfanttodie.【高危因素Riskfactors】①精神过度紧张；②寒冷季节或气压升高时；③年轻初产妇＜18岁或高龄初产妇＞40岁；④有慢性高血压、肾炎、糖尿病等病史的孕妇；⑤营养不良者或者体形较胖者；⑥低社会经济状况；⑦子宫张力过高者，如双胎、羊水过多；⑧家族中有高血压病史；①thespiritualhypertension；②inthecoldreasonsorincreasedbarometricpressure；③nulliparity，maternalagebelow20orover35；④PasthistoryofD.M,HypertensionandRenaldiseases；⑤malnutrition；Obesity；⑥lowsocioeconomicstatus⑦Multiplegestation,polyhydramnios；⑧Familyhistoryofhypertension；【病因pathogenesis】可能与异常滋养细胞侵入子宫肌层、免疫机制、血管内皮细胞受损、遗传因素、营养缺乏、胰岛素抵抗等有关。pathogenesis:Sometheoriesinclude(1)endothelialcellinjury,(2)rejectionphenomenon(insufficientproductionofblockingantibodies),(3)compromisedplacentalperfusion,(4)alteredvascularreactivity,(5)imbalancebetweenprostacyclinandthromboxane,(6)decreasedglomerularfiltrationratewithretentionofsaltandwater,(7)decreasedintravascularvolume,(8)increasedcentralnervoussystemirritability,(9)disseminatedintravascularcoagulation,(10)uterinemusclestretch(ischemia),(11)dietaryfactors,and(12)geneticfactors.【病理生理】全身小动脉痉挛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】systemicarteriolespasmsystemicarteriolespasmangiostenosis，Increasedperipheralresistancehypertensionrenalarteriolespasm，decreasedglomerularperfusion,hypoxia-ischemiaincreasedpermeabilityofglomerular,plasmaproteinleakageproteinuriadecreasedglomerularfiltrationrateedemadecreasedplasmacolloidosmoticpressureactivationofreninangiotensinaldosteronesystemplacentabraincardiovascularliverrenin-angiotensinsystem【临床表现及分类】manifestationandcalssification(1)妊娠期高血压BP≥140/90mmHg妊娠期首次出现，并于产后12周恢复正常；尿蛋白（－）；可伴有上腹部不适或血小板减少，产后方可确诊。•Gestationalhypertensionorpregnancy-inducedhypertension(PIH)isdefinedasthedevelopmentofnewarterialhypertensioninapregnantwomanafter20weeksgestationwithoutthepresenceofproteinintheurine.Gestationalhypertensionisfurtherdividedintotransienthypertensionofpregnancyifpreeclampsiaispresentatthetimeofdeliveryandthebloodpressureisnormalby12weekspostpartum,andchronichypertensioniftheelevationinbloodpressurepersistsbeyond12weekspostpartum.•轻度：BP≥140/90mmHg，孕20周以后出现；尿蛋白≥300mg/24h或（+）。可伴有上腹不适、头痛、视力模糊等症状。•Preeclampsiaishypertensionassociatedwithproteinuriaandedema,occurringprimarilyinnulliparasafterthe20thgestationalweekandmostfrequentlynearterm.Thereare2categoriesofpreeclampsia,mildandsevere.•mildpreeclampsiaisdefinedasthefollowing:(1)HTN(BP≥140/90mmHg);(2)proteinuriaexceeding0.3gina24-hourperiodor1-2+ondipsticktesting;(3)Edema(handsor/andface)withoutothersigns/symptoms(2)子痫前期preeclampsia•重度：BP≥160/110mmHg；尿蛋白≥2.0g/24h或（++）～（++++）；血肌酐＞106μmol/L；血小板＜100×109/L；微血管病性溶血（血LDH升高）；血清ALT或AST升高；持续性头痛或其它脑神经或视觉障碍；持续性上腹不适。•Severepreeclampsiaisdefinedasthefollowing:(1)bloodpressuregreaterthan160mmHgsystolicor110mmHgdiastolicon2occasions6hoursapart;(2)proteinuriaexceeding2gina24-hourperiodor2-4+ondipsticktesting;(3)increasedserumcreatinine(1.2mg/dLunlessknowntobeelevatedpreviously);(4)oliguria≤500mL/24h;(5)cerebralorvisualdisturbances;(6)epigastricpain;(7)elevatedliverenzymes;(8)thrombocytopenia(plateletcount100,000/mm3);(9)retinalhemorrhages,exudates,orpapilledema;and(10)pulmonaryedema.(2)子痫前期•子痫:子痫前期患者发生抽搐不能用其它原因解释•子痫分产前子痫、产时子痫、产后子痫，以产前子痫多见。•Eclampsiaistheoccurrenceofseizuresthatcannotbeattributedtoothercausesinapreeclampticpatient.•prenataleclampsia,intrapartumeclampsia,postpartumeclampsia•clinicalfindings：seizure，Unconsciousness，apneicphase,hyperventilatesafterthetonic-clonicseizure，Seizure-inducedcomplicationsmayincludetonguebiting,brokenbones,headtrauma,oraspiration.Pulmonaryedemaandretinaldetachment.(3)子痫Eclampsia子痫发作表现抽搐发展迅速，前驱症状短暂，表现为抽搐、面部充血、口吐白沫、深昏迷；随之深部肌肉僵硬、继而发展为典型的全身高张阵挛惊厥、有节律的肌肉收缩和紧张，持续约1～1.5min，期间无呼吸；然后抽搐停止，呼吸恢复，但患者仍昏迷。最后意识恢复，但困惑、易激惹、烦躁。(4)慢性高血压并发子痫前期高血压孕妇妊娠20周前无尿蛋白，而妊娠20周后出现尿蛋白≥300mg/24h；高血压孕妇妊娠20周后突然出现尿蛋白增加或血压进一步升高或血小板＜100×109/L。Chronichypertensionisdefinedashypertensionthatispresentbeforeconceptionorbefore20weeks'gestationorpersistenceofhypertensionafterthepuerperium(6weeks).Chronichypertensionwithsuperimposedpreeclampsia:(1)noproteinuriabeforeconception,butproteinuriaexceeding0.3gina24-hourperiodafterconception;(2)proteinuriaincreasedorbloodpressuregreaterort