妊娠高血壓疾病專業(yè)知識培訓(xùn)培訓(xùn)課件

1、妊娠高血壓疾病專業(yè)知識培訓(xùn)妊娠高血壓疾病專業(yè)知識培訓(xùn)HypertensiveDisorders complicating PregnancyGestational Hypertension PreeclampsiaPreeclampsia Superimposed on Chronic HypertensionChronic HypertensionEclampsia A Group of Related Diseases2妊娠高血壓疾病專業(yè)知識培訓(xùn)HypertensiveGestational HypertCharacteristicsSystemic small arteries spas

2、m Endothelial cell injuryHypertensionProteinuriaMultiple organs dysfunctionConvulsionMaternal mortalityFetal mortalityGestational Hypertension; Chronic hypertensionEclampsiaPreeclampsia;Preeclampsia Superimposed on Chronic Hypertension3妊娠高血壓疾病專業(yè)知識培訓(xùn)CharacteristicsSystemic small Hypertension disorder

3、s complicating pregnancyPathophysiologyCategory and clinical manifestationDiagnosis and differential diagnosisManagement and prevention病理生理臨床表現(xiàn)診斷治療4妊娠高血壓疾病專業(yè)知識培訓(xùn)Hypertension disorders complicEpidemiologyIncidence： 6-9%Preeclampsia-eclampsia：70%Chronic Hypertension ： 30%Eclampsia0.5% - 1%China 1.0%Ov

4、erseas 0.5%Reflection of medical level The second cause of maternal death (20%)Cause of premature delivery（10%）Unknown origin5妊娠高血壓疾病專業(yè)知識培訓(xùn)EpidemiologyIncidence： 6-9%5妊娠Pathophysiology Basic pathological changesSpasm of systemic small arteries Vascular endothelial cell injury6妊娠高血壓疾病專業(yè)知識培訓(xùn)Pathophysi

5、ology Basic pathologPathophysiologyfluidproteinHypertensionEdemaProteinuriaHemoconcentrationSmall arterial spasmEndothelial cell injuryMultiple organs dysfunctionIschemiaEdemamalfunction7妊娠高血壓疾病專業(yè)知識培訓(xùn)PathophysiologyfluidproteinHypSystemic Disease8妊娠高血壓疾病專業(yè)知識培訓(xùn)Systemic Disease8妊娠高血壓疾病專業(yè)知識培訓(xùn)BrainHydro

6、cephalusHyperemia/ischemia Thrombosiscerebral hemorrhagecerebral herniaheadachedazzlenauseavomitHypopsiaretinal detachment Cortical blindnessDysesthesiaConfusion of thinking Eclampsiaconvulsion comabrain：Vasospasmpermeability9妊娠高血壓疾病專業(yè)知識培訓(xùn)BrainHydrocephalusheadacheHypokidney renal vasospasmrenal blo

7、od 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妊娠高血壓疾

8、病專業(yè)知識培訓(xùn)kidney renal vasospasmrenal blliverhepatic vasospasm;hepatic ischemia;hepatic edema liver enlargement; hepatic dysfunction elevated liver enzymejaundice hypoproteinemia coagulation function changed severe：Periportal necrosishepatic subcapsularhematomahepatorrhexis HELLP symdrome:Elevated hepa

9、tic enzymesDecreased blood platelet11妊娠高血壓疾病專業(yè)知識培訓(xùn)liverhepatic vasospasm;liver eCardiovascular System Blood Pressure Vasospasm Vascular Resistance Cardiac Load heart failure vasospasm Myocardial IschemiaInterstitial EdemaSpotty Necrosis pulmonary vasospasm Pulmonary Hypertension Pulmonary EdemaOligu

10、riawater-sodium retentionRelative Blood Volume ExcessIatrogenic Blood Volume ExcessHigh burdenPoor ability12妊娠高血壓疾病專業(yè)知識培訓(xùn)Cardiovascular System Blood Prblood system Relative hypovolemiaAnemiaDecreased blood plateletHypercoagulability blood clotting factor13妊娠高血壓疾病專業(yè)知識培訓(xùn)blood system Relative hypovolep

11、lacenta-fetusplacenta Placental hypoperfusionSpiral arteries sclerosis Placental InfarctionPlacental AbruptionPlacental function decreasesfetus IUGRfetal distressoligohydramniosfetal death 14妊娠高血壓疾病專業(yè)知識培訓(xùn)placenta-fetusplacenta fetPathophysiologyBrainHeadache; visual blurred; coma; herniaKidneyRenal

12、function compromised; proteinuria; renal failureLiverPersistent upper right abdominal pain; Elevated enzyme; jaundice; hematoma; ruptureSystematic disease15妊娠高血壓疾病專業(yè)知識培訓(xùn)PathophysiologyBrainSystematicPathophysiologyCardiovascular systemLow output- high resistance; myocardial ischemia; pulmonary hyper

13、tension; edema; heart failureBloodLow volume; hypercoagulability; DIC16妊娠高血壓疾病專業(yè)知識培訓(xùn)PathophysiologyCardiovascular PathophysiologyUterus and PlacentaLow perfusion; placental atherosclerosisPlacental infarction; placental abruption; fetal growth retardation; fetal death17妊娠高血壓疾病專業(yè)知識培訓(xùn)PathophysiologyUt

14、erus and PlacHigh risk factorsPrimipara40yMultiple pregnancyHypertensionChronic nephritisMalnutritionPoor social statusDiabetesAnti-phospholipid syndromeAngiotensin gene T235 (+)18妊娠高血壓疾病專業(yè)知識培訓(xùn)High risk factorsPrimiparaAntiEtiologyGenetic susceptibility hypothesisImmune maladaptation hypothesisPlace

15、ntal ischemia hypothesisOxidative stress hypothesis19妊娠高血壓疾病專業(yè)知識培訓(xùn)EtiologyGenetic susceptibility Genetic susceptibilityImmune maladaptationPlacental ischemiaOxidativestressAbnormal placentalThe change of cytokinePEdevelopmentEndothelium injuredDICComplications20妊娠高血壓疾病專業(yè)知識培訓(xùn) Genetic susceptibilityIm

16、mune Genetic susceptibility hypothesisHypertension21妊娠高血壓疾病專業(yè)知識培訓(xùn)Genetic susceptibility hypotheImmune maladaptation hypothesisMultiple gestationAbortion and blood transfusionOvum and sperm donation22妊娠高血壓疾病專業(yè)知識培訓(xùn)Immune maladaptation hypothesiPlacental ischemia hypothesis40% total spiral artery area

17、compared to normal pregnancyEndothelial cell injury23妊娠高血壓疾病專業(yè)知識培訓(xùn)Placental ischemia hypothesis4Oxidative stress hypothesisOxidative stress reactionEndothelial cell injury24妊娠高血壓疾病專業(yè)知識培訓(xùn)Oxidative stress hypothesisOxiCategory and clinical manifestationGestational hypertension PreeclampsiaEclampsia Ch

18、ronic hypertensionPreeclampsia superimposed on chronic hypertension25妊娠高血壓疾病專業(yè)知識培訓(xùn)Category and clinical manifestclinical features typical : hypertension、albuminuria、edemauntypical ：asymptomatic severe：nausea、vomitheadache、dazzleconvulsion 、comachest distress 、palpitation 26妊娠高血壓疾病專業(yè)知識培訓(xùn)clinical feat

19、ures typical : Gestational Hypertension Definition Hypertension occurs 20 weeks after gestation and recovers 12 weeks postpartumSBP=140mmHgDBP =90mmHgDiagnosed only after delivery27妊娠高血壓疾病專業(yè)知識培訓(xùn)Gestational Hypertension DefinPreeclampsiaHypertention occurs 20 weeks after gestation BP=140/90mmHgProtei

20、nuria Proteinuria 300mg/24h Urine protein （+）Other symptomsHeadache, visual blurringUpper abdominal pain28妊娠高血壓疾病專業(yè)知識培訓(xùn)PreeclampsiaHypertention occurSevere preeclampsiaAt least one of the following features：Central nervous system abnormalities Hepatic subcapsular hematoma / hepatorrhexisHepatocyte i

21、njury :GPTBlood pressure：SBP160mmHg，or DBP110mmHgThrombocytopenia: 100109/LProteinuria: 5g/24h or (+) 4 hours apart Oliguria: 500ml/24hPulmonary edema Cerebrovascular accidentIntravascular hemolysis : anemia, jaundiceCoagulation dysfunctionFetal growth restriction / oligohydramnios29妊娠高血壓疾病專業(yè)知識培訓(xùn)Sev

22、ere preeclampsiaAt least onSevere preeclampsia complicationsHepatic subcapsularhematoma Early-onset preeclampsia : 20.5mol/LElevated serum level of Liver enzymesAST70u/L, or 3SDLDH600u/LLow PlateletsPLC100*109/L31妊娠高血壓疾病專業(yè)知識培訓(xùn)HELLP syndromeHemolysisElevateHELLPSevere preeclampsia ：One abnormalities

23、6%Two abnormalities 12%Three abnormalities10%20 gw seldom occur1/3 occur after delivery80% diagnosed prenatally32妊娠高血壓疾病專業(yè)知識培訓(xùn)HELLPSevere preeclampsia ：32妊娠HELLPclinical diagnosis Might be asymptomatic pain in the right upper abdomen80% weight gain or severe edema 50-60%20% cases 140/90 mmHg6% cases

24、 without proteinuria33妊娠高血壓疾病專業(yè)知識培訓(xùn)HELLPclinical diagnosis MighSome investigatiors regard HELLP syndrome as an entirely distinct disease entity from preeclampsia34妊娠高血壓疾病專業(yè)知識培訓(xùn)Some investigatiors regard HELClassification of HELLPBy degree of thrombocytopenia：100,000/mm3Not widely accepted35妊娠高血壓疾病專業(yè)

25、知識培訓(xùn)Classification of HELLPBy degrPathogenesis and epidemic characteristics of HELLP core mechanismendothelial injuryintravascular coagulation dysfunctionpredisposing factorsthe whitemultipara elder pregnant women36妊娠高血壓疾病專業(yè)知識培訓(xùn)Pathogenesis and epidemic charHELLP-mortalityMaternal 0-24%hepatorrhexis

26、DICAcute renal failurethrombosiscerebrovascular accidentsPerinatal 7.7-60%Premature deliveryIUGRplacental abruption 37妊娠高血壓疾病專業(yè)知識培訓(xùn)HELLP-mortalityMaternal 0-2Eclampsiaprocess：tonusconvulsionsleepinesscoma Occurrenceprenatalintrapartumpostpartum 38妊娠高血壓疾病專業(yè)知識培訓(xùn)Eclampsiaprocess：Occurrence38妊妊娠高血壓疾病專業(yè)知

27、識培訓(xùn)培訓(xùn)課件preeclampsia superimposed upon chronic hypertensionChronic Hypertension Before 20 gestational weeksPersist 12 weeks postpartumProteinuriaBefore 20wAfter 20w; with higher BP; thrombocytopenia40妊娠高血壓疾病專業(yè)知識培訓(xùn)preeclampsia superimposed uponDifferential diagnosisChronic nephritis complicating pregn

28、ancyRenal dysfunctionSeizure caused by other reasons41妊娠高血壓疾病專業(yè)知識培訓(xùn)Differential diagnosisChronic ManagementPrincipleSedationAnti-spasmAnti-hypertensionDiuresisTerminate pregnancy timely42妊娠高血壓疾病專業(yè)知識培訓(xùn)ManagementPrinciple42妊娠高血壓疾病專業(yè)ManagementCommon treatmentRestMonitoringOxygen inhalationDiet: salt re

29、striction only for anasarca patients43妊娠高血壓疾病專業(yè)知識培訓(xùn)ManagementCommon treatment43妊娠ManagementSedationDiazepamHibernation drugsPethidineChlorpromazinePromethazine44妊娠高血壓疾病專業(yè)知識培訓(xùn)ManagementSedation44妊娠高血壓疾病專業(yè)知ManagementAnti-spasmFirst line treatment for pre-eclampsia and eclampsiaMgSO4 MechanismRegimen 2

30、5-30g/dLoading dose: 25% MgSO4 10ml +10%GS 20ml iv 5-10min25% MgSO4 60ml +5%GS 500ml ivgtt 1-2g/h25% MgSO4 20ml +2%lidocaine 2ml im. 45妊娠高血壓疾病專業(yè)知識培訓(xùn)ManagementAnti-spasm45妊娠高血壓疾病專ManagementMgSO4Treatment concentration 1.7-3mmol/LToxic concentration 3mmol/LToxicityMuscular paralysisPrevention and treatmentBefore treatmentKnee reflex (+); R16bpm; urine5ml/h or 600ml/24hMg concentration monitoring If something happens10% calcium gluconate 10ml iv for detoxificationLower dose or stop use when re