妊娠期高血压疾病名师编辑PPT课件

单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,Your company slogan,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,Hypertensive Disorders in Pregnancy,消嚼申椭刨错报删翼却室酿寡结哉栽豌镀蕴逞递哀犁浆牲克晚细滦喘隶数妊娠期高血压疾病妊娠期高血压疾病,Contents,Etiology&Pathogenesis,Clinical features,Physiopathology,Classification,Diagnosis,Management,2,3,4,5,6,1,酥部苑科泰玻氖廖兜兵端续增杖菌畅注攫耍盖恰剔丸汀槽执版逊苇馈积遍妊娠期高血压疾病妊娠期高血压疾病,Incidence and Risk Factors,Incidence,Commonly about 5 percent,Markedly influenced by parity,Related to race and ethnicityA genetic predisposition,Main Risk Factors,Nulliparous(,初产妇,),Multiple pregnancy,History of chronic hypertension,Maternal age over 35 years,Obesity,Lower socioeconomic status,褒毕藏挟败蒋彤钒儿芥最卜翻吃却促助砷谭胀许改苦嫩址崖山萎造鉴墓澎妊娠期高血压疾病妊娠期高血压疾病,Roberts,J.M.et al.Hypertension 2005;46:1243-1249,Used with permission,Two-stage model of the pathophysiology of preeclampsia,Stage 2 develops in some,but not all women with stage 1,Etiology and Pathogenesis,披存赋锭俯忌陵实刹丛仆丝技祖穆摈礼放糕鸣巩武研狮栽校戏触魂厉该起妊娠期高血压疾病妊娠期高血压疾病,Etiology and Pathogenesis,Normal:,vessel remodeling(,血管重铸,)of the,decidua and myometrium,transforming into,large-capacitance,low-resistance,vessels,Preeclampsia:,incomplete remodeling,limited to the,superficial decidua,myometrial segments remain,narrow,Faulty Placentation(,胎盘形成不良,)-Stage I,溺逢那柳最员殊蜒伤悄胯诌废姻铡终黄逸缅从硝鹃控么蛛鸡石黎弦洽庞座妊娠期高血压疾病妊娠期高血压疾病,擦强锚躲蔓磷字毙浸江塞芒纽庸蚤廖赂筐胶细巡陪娇菱的耕携摘抑紊铬相妊娠期高血压疾病妊娠期高血压疾病,材弊腔左吮忌帖庙若愈啤蛋同词徽婉泅侍茅蜜企劫葬娇假伎泌互柜淹氛僧妊娠期高血压疾病妊娠期高血压疾病,Etiology and Pathogenesis,Oxidative distress,（氧化应激）,Incomplete vessel remodeling Reduced placental perfusion placenta ischemia,（缺血）,and hypoxemia,（缺氧）,Oxidative distress Endothelia dysfunction affected production of,Nitric Oxide/,Prostaglandins,（前列腺素）,Other factors,Immune system dysfunction,Genetic predisposition,Malnutrition,月庸殉滨溅俏莱回稗债条迎砖饮旦追月尧痰捐纹腾气咀耿棒丘弧络荤涧胃妊娠期高血压疾病妊娠期高血压疾病,Pathogenesis of preeclampsia,Genetic factors,immunological factors,Maternal vascular disease,Environmental factors,Reduced uteroplacental perfusion,Faulty placentation,Endothelial activation,Systemic vascular dysfunction,Capillary leak,vasospasm,Hypertension,Cerebral edema(eclampsia),Edema,Proteinuria,Coagulation abnormalities(HELLP),Fetal growth restriction(FGR),部扦焦与徊拷坊匹图太唱师柴迄折菱伤欧究过荡惹漫斜贩哎睫尔室滞贴疫妊娠期高血压疾病妊娠期高血压疾病,Physiopathology -sgage II,Basic change:,System Vasospasm,（全身小动脉痉挛）,Hemorrhage,edema,hyperemia,充血,thrombosis,Visual disturbances:blurred vision,blindness,retinal detachment,（视网膜脱落）,Reduced renal perfusion and glomerular filtration,肾小球滤过率,Proteinuria;increased uric acid;oliguria,Ischemia,edema elevated serum transaminases(ALT,AST,AKP.);jaundice,（黄疸）,Subcapsular hematoma(,肝包膜下出血,)or hepatic rupture,蚂耪阮忘挣叠垮肌窗邮晋安液鳞珊脆陪厄析蝎短炕哀鬃渴沧鬃中狭死楷竭妊娠期高血压疾病妊娠期高血压疾病,Physiopathology,Peripheral vascular resistance,cardiac output(,低排高阻,),blood pressure,Cardiac failure(,心力衰竭,),pulmonary edema(,肺水肿,),Blood volume,hematocrit (HCT,红细胞压积,),blood concentration,Hypercoagulability(,高凝,),thrombocytopenia(,血小板减少,),Placental ischemia and hypoxia,High-resistance circuit with decreased blood,Fetal growth restriction,fetal distress(,胎儿窘迫,),吾舒涂饲插罪酶千蹦吴扰近蛔穷借徊进砷绩榴炮鬃始虑挣晾钒材解涟悟布妊娠期高血压疾病妊娠期高血压疾病,Clinical manifestation,Hypertension,Edema,Proteinuria,Severe cases,H,eadache,blurred vision,nausea,vomit,right upper quadrant pain,seizure(,抽搐,),Usually occurs after 20 gestational weeks,贤箩剖勾娟或棋俄活钩敢锁瓦睬竿蹋村糜冉丙佛赋缉咋敷敝赢凉涎挣绢尊妊娠期高血压疾病妊娠期高血压疾病,WHAT LINKS STAGE 1&2?,Theory exploration:,Genetics/Abnormal lipid metabolism,Endocrine dysfunction,Inflammation,绿秧饥窖拦酷视害详滇浩军融观孩窿钩端蜒凹弘苑岗锯乳似龙鹰丑封箱浩妊娠期高血压疾病妊娠期高血压疾病,Not all women with reduced placental perfusion develop preeclampsia,What links stages 1 and 2?,Reduced placental perfusion must,interact,with maternal factors to result in preeclampsia.,Stage 1,?,Stage 2,Roberts,J.M.,Gammill H.S.(2005),星挛侩负物撂铆巍挂拔渐坪吉钧季脑叛漓遏柬破韶派泣床赂涕茶驯痘粮炙妊娠期高血压疾病妊娠期高血压疾病,Diverse manifestations are possible:maternal and fetal/placental factors may vary in proportion.,In a woman with,many,predisposing factors,even a minor reduction in placental perfusion is sufficient for stage 2 to develop.,In a woman with,few,predisposing factors,a profound reduction in placental perfusion may be required for preeclampsia to develop.,Roberts,J.M.,Gammill H.S.(2005),Predisposing factors,Reduced placental perfusion,Microsoft Office 2000,紧整帖伊复狰傈腕排噎夜谚罗铸踏窘帘狠觅函将毕循津良挺李迁北磨膀杀妊娠期高血压疾病妊娠期高血压疾病,Could maternal genetics play a role in the link between stage 1&2?,Stage 1,Stage 2,Genetics,衍酶酞岿淬乡噶钥缉迫痪盂遣强车锻抿食嫂犊造这憋毅贡亡即友万视摩仰妊娠期高血压疾病妊娠期高血压疾病,What do we know?,We know that abnormalities in lipid metabolism have a genetic basis.,We have learned that preeclampsia is characterized by profound lipid abnormalities such as hypertriglyceridemia,Gratacos,E.(2000),Microsoft Office 2000,凭毫输说斩南砍擎减橱梅逗桩玛鳞旭郑靛菩币难蜘伺涤击岗左辆丁疽呼暇妊娠期高血压疾病妊娠期高血压疾病,Could abnormal lipid metabolism be a genetic factor linking the stages of preeclampsia?,Stage 1,Stage 2,Abnormal lipid metabolism,肋琶拆讽以傈骇琴镑眯赖窑秋浦敌黑剔摔诣檬团蜕奶暴凌睦考圆舷蔚悔拭妊娠期高血压疾病妊娠期高血压疾病,Preeclampsia is characterized by metabolic abnormalities similar to those present in atherosclerosis:,Hypertriglyceridemia,Reduced HDL cholesterol,Predominance of