常见妊娠高血压疾病专家解读培训ppt课件

常常见妊娠高血妊娠高血压疾病疾病专家解家解读常见妊娠高血压疾病专家解读1HypertensiveDisorders complicating PregnancyGestational Hypertension PreeclampsiaPreeclampsia Superimposed on Chronic HypertensionChronic HypertensionEclampsia A Group of Related Diseases2常见妊娠高血压疾病专家解读HypertensiveGestational Hypert2CharacteristicsSystemic small arteries spasm Endothelial cell injuryHypertensionProteinuriaMultiple organs dysfunctionConvulsionMaternal mortalityFetal mortalityGestational Hypertension;Chronic hypertensionEclampsiaPreeclampsia;Preeclampsia Superimposed on Chronic Hypertension3常见妊娠高血压疾病专家解读CharacteristicsSystemic small 3Hypertension disorders complicating pregnancynPathophysiologynCategory and clinical manifestationnDiagnosis and differential diagnosisnManagement and prevention病理生理病理生理临床表现临床表现诊断诊断治疗治疗4常见妊娠高血压疾病专家解读Hypertension disorders complic4EpidemiologynIncidence：6-9%nPreeclampsia-eclampsia：70%nChronic Hypertension：30%nEclampsia0.5%-1%nChina 1.0%nOverseas 0.5%nReflection of medical level nThe second cause of maternal death(20%)nCause of premature delivery（10%）nUnknown origin5常见妊娠高血压疾病专家解读EpidemiologyIncidence：6-9%5常见5Pathophysiology nBasic pathological changesnSpasm of systemic small arteries nVascular endothelial cell injury6常见妊娠高血压疾病专家解读Pathophysiology Basic patholog6PathophysiologyfluidproteinHypertensionEdemaProteinuriaHemoconcentrationSmall arterial spasmEndothelial cell injuryMultiple organs dysfunctionIschemiaEdemamalfunction7常见妊娠高血压疾病专家解读PathophysiologyfluidproteinHyp7Systemic Disease8常见妊娠高血压疾病专家解读Systemic Disease8常见妊娠高血压疾病专家解读8BrainHydrocephalusHyperemia/ischemia Thrombosiscerebral hemorrhagecerebral herniaheadachedazzlenauseavomitHypopsiaretinal detachment Cortical blindnessDysesthesiaConfusion of thinking Eclampsiaconvulsion comabrain：Vasospasmpermeability9常见妊娠高血压疾病专家解读BrainHydrocephalusheadacheHypo9kidney renal vasospasmrenal blood flow glomerular filtration rate pathology：Glomerular expansion swollen vascular endothelial cellcellulose depositionrenocortical necrosisrenal irreversible damageclinical manifestation：albuminuriahypoproteinemiarenal dysfunction creatinine urea nitrogen uric acid oliguria renal failure 10常见妊娠高血压疾病专家解读kidney renal vasospasmrenal bl10liverhepatic vasospasm;hepatic ischemia;hepatic edema liver enlargement;hepatic dysfunction elevated liver enzymejaundice hypoproteinemia coagulation function changed severe：Periportal necrosishepatic subcapsularhematomahepatorrhexis HELLP symdrome:Elevated hepatic enzymesDecreased blood platelet11常见妊娠高血压疾病专家解读liverhepatic vasospasm;liver e11Cardiovascular System Blood Pressure Vasospasm Vascular Resistance Cardiac Load heart failure vasospasm Myocardial IschemiaInterstitial EdemaSpotty Necrosis pulmonary vasospasm Pulmonary Hypertension Pulmonary EdemaOliguriawater-sodium retentionRelative Blood Volume ExcessIatrogenic Blood Volume ExcessHigh burdenPoor ability12常见妊娠高血压疾病专家解读Cardiovascular System Blood Pr12blood system nRelative hypovolemianAnemianDecreased blood plateletnHypercoagulability nblood clotting factor13常见妊娠高血压疾病专家解读blood system Relative hypovole13placenta-fetusnplacenta nPlacental hypoperfusionnSpiral arteries sclerosis nPlacental InfarctionnPlacental AbruptionnPlacental function decreasesofetus nIUGRnfetal distressnoligohydramniosnfetal death 14常见妊娠高血压疾病专家解读placenta-fetusplacenta fet14PathophysiologynBrainnHeadache;visual blurred;coma;hernianKidneynRenal function compromised;proteinuria;renal failurenLivernPersistent upper right abdominal pain;Elevated enzyme;jaundice;hematoma;ruptureSystematic disease15常见妊娠高血压疾病专家解读PathophysiologyBrainSystematic15PathophysiologynCardiovascular systemnLow output-high resistance;myocardial ischemia;pulmonary hypertension;edema;heart failurenBloodnLow volume;hypercoagulability;DIC16常见妊娠高血压疾病专家解读PathophysiologyCardiovascular 16PathophysiologynUterus and PlacentanLow perfusion;placental atherosclerosisnPlacental infarction;placental abruption;fetal growth retardation;fetal death17常见妊娠高血压疾病专家解读PathophysiologyUterus and Plac17High risk factorsnPrimiparan40ynMultiple pregnancynHypertensionnChronic nephritisnMalnutritionnPoor social statusnDiabetesnAnti-phospholipid syndromenAngiotensin gene T235(+)18常见妊娠高血压疾病专家解读High risk factorsPrimiparaAnti18EtiologynGenetic susceptibility hypothesisnImmune maladaptation hypothesisnPlacental ischemia hypothesisnOxidative stress hypothesis19常见妊娠高血压疾病专家解读EtiologyGenetic susceptibility19 Immune maladaptationPlacental ischemiaOxidativestressAbnormal placentalThe change of cytokinePEdevelopmentEndothelium injuredDICComplications20常见妊娠高血压疾病专家解读 Genetic susceptibilityImmune 20Genetic susceptibility hypothesisHypertension21常见妊娠高血压疾病专家解读Genetic susceptibility hypothe21Immune maladaptation hypothesisnMultiple gestationnAbortion and blood transfusionnOvum and sperm donation22常见妊娠高血压疾病专家解读Immune maladaptation hypothesi22Placental ischemia hypothesisn40%total spiral artery area compared to normal pregnancynEndothelial cell injury23常见妊娠高血压疾病专家解读Placental ischemia hypothesis423Oxidative stress hypothesisOxidative stress reactionEndothelial cell injury24常见妊娠高血压疾病专家解读Oxidative stress hypothesisOxi24Category and clinical manifestationnGestational hypertension nPreeclampsianEclampsia nChronic hypertensionnPreeclampsia superimposed on chronic hypertension25常见妊娠高血压疾病专家解读Category and clinical manifest25clinical features ntypical:nhypertension、albuminuria、edemanuntypical：nasymptomatic nsevere：nnausea、vomitnheadache、dazzlenconvulsion、comanchest distress、palpitation 26常见妊娠高血压疾病专家解读clinical features typical:26Gestational Hypertension nDefinition nHypertension occurs 20 weeks after gestation and recovers 12 weeks postpartumnSBP=140mmHgnDBP=90mmHgnDiagnosed only after delivery27常见妊娠高血压疾病专家解读Gestational Hypertension Defin27PreeclampsianHypertention occurs 20 weeks after gestation nBP=140/90mmHgnProteinuria nProteinuria 300mg/24h nUrine protein（+）nOther symptomsnHeadache,visual blurringnUpper abdominal pain28常见妊娠高血压疾病专家解读PreeclampsiaHypertention occur28Severe preeclampsianAt least one of the following features：nCentral nervous system abnormalities nHepatic subcapsular hematoma/hepatorrhexisnHepatocyte injury:GPTnBlood pressure：SBP160mmHg，or DBP110mmHgnThrombocytopenia:100109/LnProteinuria:5g/24h or(+)4 hours apart nOliguria:500ml/24hnPulmonary edema nCerebrovascular accidentnIntravascular hemolysis:anemia,jaundicenCoagulation dysfunctionnFetal growth restriction/oligohydramnios29常见妊娠高血压疾病专家解读Severe preeclampsiaAt least on29Severe preeclampsia complicationsHepatic subcapsularhematoma Early-onset preeclampsia:20.5mol/LnElevated serum level of Liver enzymesnAST70u/L,or 3SDnLDH600u/LnLow PlateletsnPLC100*109/L31常见妊娠高血压疾病专家解读HELLP syndromeHemolysisElevate31HELLPnSevere preeclampsia：nOne abnormalities 6%nTwo abnormalities 12%nThree abnormalities 10%n20 gw seldom occurn1/3 occur after deliveryn80%diagnosed prenatally32常见妊娠高血压疾病专家解读HELLPSevere preeclampsia：32常见32HELLPclinical diagnosis nMight be asymptomatic npain in the right upper abdomen80%n weight gain or severe edema 50-60%n20%cases 140/90 mmHgn6%cases without proteinuria33常见妊娠高血压疾病专家解读HELLPclinical diagnosis Migh33nSome investigatiors regard HELLP syndrome as an entirely distinct disease entity from preeclampsia34常见妊娠高血压疾病专家解读Some investigatiors regard HEL34Classification of HELLPnBy degree of thrombocytopenia：n100,000/mm3nNot widely accepted35常见妊娠高血压疾病专家解读Classification of HELLPBy degr35Pathogenesis and epidemic characteristics of HELLP ncore mechanismnendothelial injuryintravascular coagulation dysfunctionnpredisposing factorsnthe whitenmultipara nelder pregnant women36常见妊娠高血压疾病专家解读Pathogenesis and epidemic char36HELLP-mortalitynMaternal 0-24%nhepatorrhexisnDICnAcute renal failurenthrombosisncerebrovascular accidentsnPerinatal 7.7-60%nPremature deliverynIUGRnplacental abruption 37常见妊娠高血压疾病专家解读HELLP-mortalityMaternal 0-237Eclampsianprocess：ntonusnconvulsionnsleepinessncoma nOccurrencenprenatalnintrapartumnpostpartum 38常见妊娠高血压疾病专家解读Eclampsiaprocess：Occurrence38常38常见妊娠高血压疾病专家解读培训ppt课件39preeclampsia superimposed upon chronic hypertensionnChronic Hypertension nBefore 20 gestational weeksnPersist 12 weeks postpartumnProteinurianBefore 20wnAfter 20w;with higher BP;thrombocytopenia40常见妊娠高血压疾病专家解读preeclampsia superimposed upon40Differential diagnosisnChronic nephritis complicating pregnancynRenal dysfunctionnSeizure caused by other reasons41常见妊娠高血压疾病专家解读Differential diagnosisChronic 41ManagementnPrinciplenSedationnAnti-spasmnAnti-hypertensionnDiuresisnTerminate pregnancy timely42常见妊娠高血压疾病专家解读ManagementPrinciple42常见妊娠高血压疾病42ManagementnCommon treatmentnRestnMonitoringnOxygen inhalationnDiet:salt restriction only for anasarca patients43常见妊娠高血压疾病专家解读ManagementCommon treatment43常见43ManagementnSedationnDiazepamnHibernation drugsnPethidinenChlorpromazinenPromethazine44常见妊娠高血压疾病专家解读ManagementSedation44常见妊娠高血压疾病专44ManagementnAnti-spasmnFirst line treatment for pre-eclampsia and eclampsianMgSO4 nMechanismnRegimen 25-30g/dnLoading dose:25%MgSO4 10ml+10%GS 20ml iv 5-10minn25%MgSO4 60ml+5%GS 500ml ivgtt 1-2g/hn25%MgSO4 20ml+2%lidocaine 2ml im.45常见妊娠高血压疾病专家解读ManagementAnti-spasm45常见妊娠高血压疾45ManagementnMgSO4nTreatment concentration 1.7-3mmol/LnToxic concentration 3mmol/LnToxicitynMuscular paralysisnPrevention and treatmentIBefore treatmentKnee reflex(+);R16bpm;urine5ml/h or 600ml/24hMg concentration monitoring nIf something happensn10%calcium gluconate 10ml iv for detoxificationnLower dose or stop use when renal dysfunction46常见妊娠高血压疾病专家解读ManagementMgSO446常见妊娠高血压疾病专家解读46ManagementnAntihypertensionnIndication nSBP160mmHg,DBP 110mmHg,MBP 140mmHgnPrinciplenNo feral toxicity;no lower renal and uterine perfusionnHydralazine first linenLabetalol;calcium channel blocker;methyldopanSodium nitroprusside-only when unmanageable BP nACEI-contraindicated during pregnancy47常见妊娠高血压疾病专家解读ManagementAntihypertension47常见47ManagementnVolumetric dilatancy-only for severe Hypoproteinemia and anemianDiuretic agent-only for severe edema48常见妊娠高血压疾病专家解读ManagementVolumetric dilatancy48ManagementnTerminate pregnancynSevere pre-eclampsia unrelieved after active treatment for 24-48 hoursnSevere pre-eclampsia,34 wnSevere pre-eclampsia,34 w with matured fetus and placental dysfunctionnSevere pre-eclampsia,150-180mmHg;DBP100mmHg;hypertension related organ dysfunction52常见妊娠高血压疾病专家解读ManagementChronic hypertension52PreventionnA well organized health care systemnA well monitored pregnant periodnAppropriate diet and rest53常见妊娠高血压疾病专家解读PreventionA well organized hea53