妊娠高血壓疾病培訓(xùn)培訓(xùn)課件

1、妊娠高血壓疾病培訓(xùn)命名妊娠高血壓綜合癥（妊高征）Pregnancy induced hypertension妊娠高血壓疾病Hypertensive disorder of pregnancy妊娠期高血壓Gestational hypertension先兆子癇（preeclampsia)子癇前期（preeclampsia）2妊娠高血壓疾病培訓(xùn)以往的分類妊娠高血壓綜合癥（妊高征）（pregnancy induced hypertension, PIH）輕度（mild）中度（middle）重度（severe）先兆子癇（preeclampsia）子癇（eclampsia）3妊娠高血壓疾病培訓(xùn)新的分類妊

2、娠高血壓疾病(hypertensive disorder of pregnancy)妊娠高血壓（gestational hypertension）子癇前期（preeclampsia）輕度（mild）重度（severe）子癇（eclampsia）慢性高血壓合并妊娠（ Chronic hypertension complicating pregnancy ）慢性高血壓病發(fā)子癇前期（Pre-eclampsia superimposed upon chronic hypertension） 4妊娠高血壓疾病培訓(xùn)區(qū)別輕度妊高征BP: 140/90-160/110 mmHg或升高=30/15mmHg蛋白尿

3、：- or +-中度妊高征血壓=160/110mmHg or 蛋白尿 = +先兆子癇：出現(xiàn)臨床癥狀妊娠期高血壓血壓=140/90mmHg無蛋白尿子癇前期輕度：高血壓+蛋白尿重度：BP=160/110mmHg蛋白尿+ or 5g/d其他并發(fā)癥5妊娠高血壓疾病培訓(xùn)重度子癇前期下列標(biāo)準(zhǔn)至少一條符合者可診斷為重度子癇前期：中樞神經(jīng)系統(tǒng)異常表現(xiàn)：視力模糊、頭痛、頭暈；嚴(yán)重者神志不清、昏迷等肝包膜下血腫或肝破裂的癥狀：包括上腹部不適或右上腹持續(xù)性疼痛等肝細(xì)胞損傷的表現(xiàn)：血清轉(zhuǎn)氨酶升高血壓改變：收縮壓P160mmHg，或舒張壓110mmHg血小板減少：100109L蛋白尿：5g/24h，或間隔4小時兩次尿蛋

4、白（+）少尿：24小時尿量100mmHg伴有高血壓導(dǎo)致的器官損傷的表現(xiàn)BP180/110mmHg需要靜脈降壓治療，首選藥物為肼苯噠嗪和柳胺芐心啶。21妊娠高血壓疾病培訓(xùn)胎兒監(jiān)護超聲檢查-動態(tài)監(jiān)測胎兒的生長發(fā)育NST或胎兒生物物理指標(biāo)監(jiān)護在妊娠28周開始每周一次妊娠32周以后每周兩次。22妊娠高血壓疾病培訓(xùn)分娩選擇終止妊娠對于輕度、沒有并發(fā)癥的慢性高血壓，可足月自然分娩；若慢性高血壓病發(fā)子癇前期，或伴其他的妊娠合并癥（如胎兒生長受限、上胎死胎史等），應(yīng)提前終止妊娠。23妊娠高血壓疾病培訓(xùn)妊高癥治療Magnesium sulfateReviewers conclusions：Magnesium s

5、ulphate appears to be substantially more effective than phenytoin for treatment of eclampsia. Reviewers conclusions： Magnesium sulphate more than halves the risk of eclampsia, and probably reduces the risk of maternal death. There do not appear to be substantive harmful effects to mother or baby in

6、the short term. ？24妊娠高血壓疾病培訓(xùn)妊高癥治療Drugs for treatment of very high blood pressure during pregnancyMain ResultsTwenty trials were included (1637 women) and 19 were excluded. There were ten different comparisons. Hydralazine was the most common drug for others to be evaluated against. Diazoxide, given

7、as 75mg bolus injections, appears to be associated with maternal hypotension requiring treatment, and ketanserin is less effective than hydralazine at reducing blood pressure. There is no other clear evidence that any one of the other antihypertensive agents is better than another for women with severe hypertension during pregnancy. 25妊娠高血壓疾病培訓(xùn)妊高癥治療Antihypertensive drug therapy for mild to moderate hypertension during pregnancyReviewers conclusions：It remains unclear whether antihypertensive drug therapy for mild-moderate hypertension during pregnancy is worthwhile. 2