妊娠期期高血壓疾病課件

第八章妊娠期并發(fā)癥婦女的護(hù)理本科《母嬰護(hù)理學(xué)》紹興文理學(xué)院

妊娠期期高血壓疾病-中英版

要點(diǎn)提示妊娠期高血壓疾病的臨床分型、各型的臨床表現(xiàn)及處理原則。Theclinicalclassification,manifestation,andthetreatmentprinciplesofdifferenthypertensionstatesofpregnancy.硫酸鎂治療妊娠期高血壓疾病的用藥方法及觀察要點(diǎn)。Theusageandobservationofthemagnesiumsulfate.

妊娠期期高血壓疾病-中英版第四節(jié)妊娠期高血壓疾病

HypertensiveStatesofPregnancy妊娠期高血壓疾病(hypertensivestatesofpregnancy)包括：妊娠期高血壓(gestationalhypertension)子癇前期(preeclampsia)子癇(eclampsia)慢性高血壓并發(fā)子癇前期(chronichypertensionwithsuperimposed

preeclampsia)妊娠合并慢性高血壓(chronichypertensioncomplicatingpregnancy)妊娠期期高血壓疾病-中英版本病以高血壓、蛋白尿、水腫為主要癥狀，可伴有全身多器官功能損害或衰竭，重者可出現(xiàn)抽搐、昏迷甚至死亡，嚴(yán)重危害母嬰健康，是孕產(chǎn)婦及圍生兒死亡的主要原因。hypertensivestatesofpregnancy：Themainsymptomsarehypertension,proteinuria,edema,accompaniedbymultipleorgandisfunctionorfailure,seriouslytobepossibletohavetwitches,thestuporevenmaternalinfanttodie.妊娠期期高血壓疾病-中英版【高危因素Riskfactors】①精神過(guò)度緊張；②寒冷季節(jié)或氣壓升高時(shí)；③年輕初產(chǎn)婦＜18歲或高齡初產(chǎn)婦＞40歲；④有慢性高血壓、腎炎、糖尿病等病史的孕婦；⑤營(yíng)養(yǎng)不良者或者體形較胖者；⑥低社會(huì)經(jīng)濟(jì)狀況；⑦子宮張力過(guò)高者，如雙胎、羊水過(guò)多；⑧家族中有高血壓病史；①thespiritualhypertension；②inthecoldreasonsorincreasedbarometricpressure；③nulliparity，maternalagebelow20orover35；④PasthistoryofD.M,HypertensionandRenaldiseases；⑤malnutrition；Obesity；⑥lowsocioeconomicstatus⑦M(jìn)ultiplegestation,polyhydramnios；⑧Familyhistoryofhypertension；妊娠期期高血壓疾病-中英版【病因pathogenesis】可能與異常滋養(yǎng)細(xì)胞侵入子宮肌層、免疫機(jī)制、血管內(nèi)皮細(xì)胞受損、遺傳因素、營(yíng)養(yǎng)缺乏、胰島素抵抗等有關(guān)。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.妊娠期期高血壓疾病-中英版【病理生理】

全身小動(dòng)脈痙攣全身小動(dòng)脈痙攣管腔狹窄，外周阻力增加血壓升高腎小動(dòng)脈痙攣，血流量減少,腎缺血缺氧腎小球通透性增加血漿蛋白漏出蛋白尿腎小球?yàn)V過(guò)率降低水腫血漿膠體滲透壓降低激活RAA系統(tǒng)胎盤腦心臟肝臟激活RAS系統(tǒng)妊娠期期高血壓疾病-中英版【pathophysiology】

systemicarteriolespasmsystemicarteriolespasmangiostenosis，Increasedperipheralresistancehypertensionrenalarteriolespasm，decreasedglomerularperfusion,hypoxia-ischemiaincreasedpermeabilityofglomerular,plasmaproteinleakageproteinuriadecreasedglomerularfiltrationrateedemadecreasedplasmacolloidosmoticpressureactivationofreninangiotensinaldosteronesystemplacentabraincardiovascularliverrenin-angiotensinsystem妊娠期期高血壓疾病-中英版【臨床表現(xiàn)及分類】

manifestationandcalssification

(1)妊娠期高血壓

BP≥140/90mmHg妊娠期首次出現(xiàn)，并于產(chǎn)后12周恢復(fù)正常；尿蛋白（－）；可伴有上腹部不適或血小板減少，產(chǎn)后方可確診。Gestationalhypertensionorpregnancy-inducedhypertension(PIH)isdefinedasthedevelopmentofnewarterialhypertensioninapregnantwomanafter20weeksgestationwithoutthepresenceofproteinintheurine.Gestationalhypertensionisfurtherdividedintotransienthypertensionofpregnancyifpreeclampsiaispresentatthetimeofdeliveryandthebloodpressureisnormalby12weekspostpartum,andchronichypertensioniftheelevationinbloodpressurepersistsbeyond12weekspostpartum.妊娠期期高血壓疾病-中英版輕度：BP≥140/90mmHg，孕20周以后出現(xiàn)；尿蛋白≥300mg/24h或（+）?？砂橛猩细共贿m、頭痛、視力模糊等癥狀。Preeclampsiaishypertensionassociatedwithproteinuriaandedema,occurringprimarilyinnulliparasafterthe20thgestationalweekandmostfrequentlynearterm.Thereare2categoriesofpreeclampsia,mildandsevere.mildpreeclampsiaisdefinedasthefollowing:(1)HTN(BP≥140/90mmHg);(2)proteinuriaexceeding0.3gina24-hourperiodor1-2+ondipsticktesting;(3)Edema(handsor/andface)withoutothersigns/symptoms(2)子癇前期preeclampsia

妊娠期期高血壓疾病-中英版重度：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；持續(xù)性頭痛或其它腦神經(jīng)或視覺(jué)障礙；持續(xù)性上腹不適。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(plateletcount<100,000/mm3);(9)retinalhemorrhages,exudates,orpapilledema;and(10)pulmonaryedema.(2)子癇前期

妊娠期期高血壓疾病-中英版子癇:子癇前期患者發(fā)生抽搐不能用其它原因解釋子癇分產(chǎn)前子癇、產(chǎn)時(shí)子癇、產(chǎn)后子癇，以產(chǎn)前子癇多見。Eclampsiaistheoccurrenceofseizuresthatcannotbeattributedtoothercausesinapreeclampticpatient.prenataleclampsia,intrapartumeclampsia,postpartumeclampsiaclinicalfindings：seizure，Unconsciousness，apneicphase,hyperventilatesafterthetonic-clonicseizure，Seizure-inducedcomplicationsmayincludetonguebiting,brokenbones,headtrauma,oraspiration.Pulmonaryedemaandretinaldetachment.(3)子癇Eclampsia

妊娠期期高血壓疾病-中英版子癇發(fā)作表現(xiàn)

抽搐發(fā)展迅速，前驅(qū)癥狀短暫，表現(xiàn)為抽搐、面部充血、口吐白沫、深昏迷；隨之深部肌肉僵硬、繼而發(fā)展為典型的全身高張陣攣驚厥、有節(jié)律的肌肉收縮和緊張，持續(xù)約1～1.5min，期間無(wú)呼吸；然后抽搐停止，呼吸恢復(fù)，但患者仍昏迷。最后意識(shí)恢復(fù)，但困惑、易激惹、煩躁。妊娠期期高血壓疾病-中英版(4)慢性高血壓并發(fā)子癇前期 高血壓孕婦妊娠20周前無(wú)尿蛋白，而妊娠20周后出現(xiàn)尿蛋白≥300mg/24h；高血壓孕婦妊娠20周后突然出現(xiàn)尿蛋白增加或血壓進(jìn)一步升高或血小板＜100×109/L。Chronichypertensionisdefinedashypertensionthatispresentbeforeconceptionorbefore20weeks'gestationorpersistenceofhypertensionafterthepuerperium(6weeks).Chronichypertensionwithsuperimposedpreeclampsia:(1)noproteinuriabeforeconception,butproteinuriaexceeding0.3gina24-hourperiodafterconception;(2)proteinuriaincreasedorbloodpressuregreaterorthrombocyte＜100×109/L

妊娠期期高血壓疾病-中英版(5)妊娠合并慢性高血壓 妊娠前或妊娠20周前血壓≥140/90mmHg，妊娠期無(wú)明顯加重；或妊娠20周后首次診斷高血壓，并持續(xù)至產(chǎn)后12周以后。definedasbloodpressureequaltoorgreaterthan140/90mmHgbeforeconceptionorbefore20weeksgestation,andthehypertensionisnotincreasedsignificantly,orhypertensionisfirstlydiagnosedafter20weeksgestationandpersistsbeyond12weekspostpartum.妊娠期期高血壓疾病-中英版并發(fā)癥腦出血、心力衰竭、肺水腫、急性腎功能衰竭、胎盤早剝、DIC、胎兒窘迫等。Complications:cerebralhemorrhage,HeartFailure,pulmonaryedema,acuterenalfailure,placentalabruption,disseminatedintravascularcoagulation,fetaldistress子癇驚厥后咬傷造成舌血腫子癇患者頭部CT箭頭處可見低密度陰影妊娠期期高血壓疾病-中英版

處理原則：妊娠期高血壓的處理原則為休息、鎮(zhèn)靜、間斷吸氧、密切監(jiān)護(hù)母兒狀態(tài)；子癇前期的處理原則為休息、鎮(zhèn)靜、解痙、降壓、合理擴(kuò)容和必要時(shí)利尿，密切監(jiān)測(cè)母兒狀態(tài)，適時(shí)終止妊娠；子癇的處理原則為控制抽搐，糾正缺氧和酸中毒，及時(shí)終止妊娠。

Rest,Sedation,Intermittentinhalationofoxygen,Closemonitoring,spasmolysis,Controlofhypertension,expandbloodvolumeanddiuretictherapy,terminationofpregnancy,Controlofseizures.【處理原則Treatment】妊娠期期高血壓疾病-中英版1．有受傷的危險(xiǎn)與發(fā)生抽搐及意識(shí)喪失有關(guān)。2．潛在并發(fā)癥胎盤早剝、腎衰竭。3．焦慮與擔(dān)心自身及胎兒安危有關(guān)。Highriskforinjury，relatedtoseizureorunconsciousness。Potentialforcomplications,relatedtorenalfailure,placentalabruptionAnxiety:relatedtoworryingaboutthesafetyofherselfandthefetus.【護(hù)理診斷nursingdiagnosis】妊娠期期高血壓疾病-中英版【護(hù)理措施】

（一）妊娠期高血壓患者的護(hù)理（二）子癇前期患者的護(hù)理（三）子癇患者的護(hù)理（四）產(chǎn)時(shí)及產(chǎn)后護(hù)理（五）心理護(hù)理（六）健康指導(dǎo)妊娠期期高血壓疾病-中英版（一）妊娠期高血壓患者的護(hù)理1．休息與睡眠可在家治療，充足的睡眠（≥10小時(shí)/日）；以左側(cè)臥位為宜。2．間斷吸氧

3．飲食指導(dǎo)蛋白質(zhì)（＞100克/日）、蔬菜，補(bǔ)充維生素、鐵和鈣劑；水腫不明顯者不必嚴(yán)格限制食鹽。4．密切監(jiān)測(cè)母兒狀況

監(jiān)測(cè)患者體重、血壓，詢問(wèn)患者有無(wú)頭痛、視力改變、上腹不適等癥狀；協(xié)助患者進(jìn)行尿蛋白測(cè)定、血液檢查、胎兒發(fā)育狀況和胎盤功能檢查Beathome,getenoughsleep:leftlateralposition.Intermittentinhalationofoxygen.DietaryGuidelines:Getclosemonitoringofthestatesofthemotherandthebaby妊娠期期高血壓疾病-中英版（二）子癇前期患者的護(hù)理1．一般護(hù)理住院治療，臥床休息，左側(cè)臥位。床旁準(zhǔn)備開口器、吸氧裝置、吸引器、產(chǎn)包等搶救物資及硫酸鎂、葡萄糖酸鈣等藥品。2．密切監(jiān)測(cè)母兒狀況3．硫酸鎂用藥護(hù)理硫酸鎂是目前治療妊娠期高血壓疾病的首選解痙藥物。Generalnursing:Behospitalized,stayinbed:leftlateralposition.Makegoodpreparationforrescuing.Closemonitoring.Medicationcareofmagnesiumsulfate:妊娠期期高血壓疾病-中英版（三）子癇患者的護(hù)理1．協(xié)助醫(yī)師控制抽搐Controlofseizures一旦發(fā)生抽搐，應(yīng)盡快控制。硫酸鎂為首選藥物，必要時(shí)可加用強(qiáng)有力的鎮(zhèn)靜劑。2．防止受傷Preventinjuries.3．避免再次抽搐avoidthesecondseizure單間，保持環(huán)境安靜，光線暗淡；治療和護(hù)理操作應(yīng)輕柔且相對(duì)集中。4．嚴(yán)密監(jiān)護(hù)病情closemonitoringandobservation密切觀察患者生命體征、神志、尿量等的變化，及早發(fā)現(xiàn)腦出血、肺水腫、急性腎衰竭、胎盤早剝等并發(fā)癥。5．做好終止妊娠的準(zhǔn)備Preparefortheterminationofpregnancy子癇發(fā)作者往往在發(fā)作后自然臨產(chǎn)，應(yīng)及時(shí)發(fā)現(xiàn)產(chǎn)兆，并做好母子搶救準(zhǔn)備。妊娠期期高血壓疾病-中英版3．硫酸鎂用藥護(hù)理

medicationnursing（1）用藥方法可采用肌內(nèi)注射或靜脈用藥。①深部肌內(nèi)注射：intramuscularinjection作用時(shí)間長(zhǎng)，但局部刺激性強(qiáng)，注射部位疼痛明顯；注射時(shí)可加利多卡因于硫酸鎂溶液中，以緩解疼痛，注射后用無(wú)菌棉球覆蓋針孔，防止注射部位感染。②靜脈用藥intravenousadministration可行靜脈滴注或推注。妊娠期期高血壓疾病-中英版（2）毒性反應(yīng)膝腱反射消失lossofdeeptendonreflexes全身肌張力減退

musclehypotonia呼吸抑制respiratoryparalysis發(fā)生心臟停搏

cardiacarrest妊娠期期高血壓疾病-中英版（3）注意事項(xiàng)應(yīng)監(jiān)測(cè)患者血壓，同時(shí)應(yīng)注意以下事項(xiàng)：①膝腱反射必須存在；②呼吸不少于16次