《妊娠高血压疾病》PPT课件.ppt

妊娠高血压疾病hypertensivedisorderinpregnancy,复旦大学附属妇产科医院李笑天教授,命名,妊娠高血压综合症（妊高征）Pregnancyinducedhypertension妊娠高血压疾病Hypertensivedisorderofpregnancy妊娠期高血压Gestationalhypertension先兆子痫（preeclampsia)子痫前期（preeclampsia）,以往的分类,妊娠高血压综合症（妊高征）（pregnancyinducedhypertension,PIH）轻度（mild）中度（middle）重度（severe）先兆子痫（preeclampsia）子痫（eclampsia）,新的分类,妊娠高血压疾病(hypertensivedisorderofpregnancy)妊娠高血压（gestationalhypertension）子痫前期（preeclampsia）轻度（mild）重度（severe）子痫（eclampsia）慢性高血压合并妊娠（Chronichypertensioncomplicatingpregnancy）慢性高血压病发子痫前期（Pre-eclampsiasuperimposeduponchronichypertension）,区别,轻度妊高征BP:140/90-160/110mmHg或升高=30/15mmHg蛋白尿：-or+-中度妊高征血压=160/110mmHgor蛋白尿=+先兆子痫：出现临床症状,妊娠期高血压血压=140/90mmHg无蛋白尿子痫前期轻度：高血压+蛋白尿重度：BP=160/110mmHg蛋白尿+or5g/d其他并发症,重度子痫前期,下列标准至少一条符合者可诊断为重度子痫前期：中枢神经系统异常表现：视力模糊、头痛、头晕；严重者神志不清、昏迷等肝包膜下血肿或肝破裂的症状：包括上腹部不适或右上腹持续性疼痛等肝细胞损伤的表现：血清转氨酶升高血压改变：收缩压P160mmHg，或舒张压110mmHg血小板减少：100109L蛋白尿：5g/24h，或间隔4小时两次尿蛋白（+）少尿：24小时尿量100mmHg伴有高血压导致的器官损伤的表现BP180/110mmHg需要静脉降压治疗，首选药物为肼苯哒嗪和柳胺苄心啶。,胎儿监护,超声检查-动态监测胎儿的生长发育NST或胎儿生物物理指标监护在妊娠28周开始每周一次妊娠32周以后每周两次。,分娩选择,终止妊娠对于轻度、没有并发症的慢性高血压，可足月自然分娩；若慢性高血压病发子痫前期，或伴其他的妊娠合并症（如胎儿生长受限、上胎死胎史等），应提前终止妊娠。,妊高症治疗,MagnesiumsulfateReviewersconclusions：Magnesiumsulphateappearstobesubstantiallymoreeffectivethanphenytoinfortreatmentofeclampsia.Reviewersconclusions：Magnesiumsulphatemorethanhalvestheriskofeclampsia,andprobablyreducestheriskofmaternaldeath.Theredonotappeartobesubstantiveharmfuleffectstomotherorbabyintheshortterm.？,妊高症治疗,DrugsfortreatmentofveryhighbloodpressureduringpregnancyMainResultsTwentytrialswereincluded(1637women)and19wereexcluded.Thereweretendifferentcomparisons.Hydralazinewasthemostcommondrugforotherstobeevaluatedagainst.Diazoxide,givenas75mgbolusinjections,appearstobeassociatedwithmaternalhypotensionrequiringtreatment,andketanserinislesseffectivethanhydralazineatreducingbloodpressure.Thereisnootherclearevidencethatanyoneoftheotherantihypertensiveagentsisbetterthananotherforwomenwithseverehypertensionduringpregnancy.,妊高症治疗,AntihypertensivedrugtherapyformildtomoderatehypertensionduringpregnancyReviewersconclusions：Itremainsunclearwhetherantihypertensivedrugtherapyformild-moderatehypertensionduringpregnancyisworthwhile.,产后咨询和随访,以下情况之一者，PE复发的风险增大：本次PE发生在30周前者本次妊娠为经产妇再次妊娠为新的父亲远期随访子痫前期的诊断越准确，远期心血管疾病的风险越低。妊娠期高血压患者的远期心血管疾病的风险高。,