妊娠期期高血壓疾病 中英版

第八章妊娠期并發(fā)癥婦女的護理本科《母嬰護理學》紹興文理學院

要點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。Theusageandobservationofthemagnesiumsulfate.

http://www.health.am/pregnancy/hypertensive-states-of-pregnancy//afp/2008/0701/p93.html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)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.http://www.health.am/pregnancy/hypertensive-states-of-pregnancy/【高危因素

Riskfactors

】①精神過度緊張；②寒冷季節(jié)或氣壓升高時；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營養(yǎng)不良者或者體形較胖者；⑥低社會經(jīng)濟狀況；⑦子宮張力過高者，如雙胎、羊水過多；⑧家族中有高血壓病史；①thespiritualhypertension；②inthecoldreasonsorincreasedbarometricpressure；③nulliparity，maternalagebelow20orover35；④PasthistoryofD.M,

Hypertension

andRenaldiseases；⑤malnutrition；Obesity；⑥lowsocioeconomicstatus⑦Multiplegestation,polyhydramnios；⑧Familyhistoryofhypertension；【病因pathogenesis】可能與異常滋養(yǎng)細胞侵入子宮肌層、免疫機制、血管內皮細胞受損、遺傳因素、營養(yǎng)缺乏、胰島素抵抗等有關。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.【病理生理】

全身小動脈痙攣全身小動脈痙攣管腔狹窄，外周阻力增加血壓升高腎小動脈痙攣，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濾過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)【pathophysiology】

systemicarteriolespasmsystemicarteriolespasmangiostenosis，Increasedperipheralresistancehypertensionrenalarteriolespasm，decreasedglomerularperfusion,hypoxia-ischemiaincreasedpermeabilityofglomerular,plasmaproteinleakageproteinuriadecreasedglomerularfiltrationrateedemadecreasedplasmacolloidosmoticpressureactivationofreninangiotensinaldosteronesystemplacentabraincardiovascularliverrenin-angiotensinsystem【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.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

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

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

子癇發(fā)作表現(xiàn)

抽搐發(fā)展迅速，前驅癥狀短暫，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，期間無呼吸；然后抽搐停止，呼吸恢復，但患者仍昏迷。最后意識恢復，但困惑、易激惹、煩躁。(4)慢性高血壓并發(fā)子癇前期 高血壓孕婦妊娠20周前無尿蛋白，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

(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。definedasbloodpressureequaltoorgreaterthan140/90mmHgbeforeconceptionorbefore

20weeksgestation,andthehypertensionisnotincreasedsignificantly,orhypertensionisfirstlydiagnosedafter20weeksgestationandpersistsbeyond12weekspostpartum.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