妊娠高血壓疾病--英文教學(xué)課件

1、Hypertension Disorders Complicating Pregnancy妊娠期高血壓疾病HypertensiveDisorders complicating PregnancyGestational Hypertension PreeclampsiaPreeclampsia Superimposed on Chronic HypertensionChronic HypertensionEclampsia A Group of Related DiseasesCharacteristicsSystemic small arteries spasm Endothelial cel

2、l injuryHypertensionProteinuriaMultiple organs dysfunctionConvulsionMaternal mortalityFetal mortalityGestational Hypertension; Chronic hypertensionEclampsiaPreeclampsia;Preeclampsia Superimposed on Chronic HypertensionHypertension disorders complicating pregnancyPathophysiologyCategory and clinical

3、manifestationDiagnosis and differential diagnosisManagement and prevention病理生理臨床表現(xiàn)診斷治療EpidemiologyIncidence： 6-9%Preeclampsia-eclampsia：70%Chronic Hypertension ： 30%Eclampsia0.5% - 1%China 1.0%Overseas 0.5%Reflection of medical level The second cause of maternal death (20%)Cause of premature deliver

4、y（10%）Unknown originPathophysiology Basic pathological changesSpasm of systemic small arteries Vascular endothelial cell injuryPathophysiologyfluidproteinHypertensionEdemaProteinuriaHemoconcentrationSmall arterial spasmEndothelial cell injuryMultiple organs dysfunctionIschemiaEdemamalfunctionSystemi

5、c DiseaseBrainHydrocephalusHyperemia/ischemia Thrombosiscerebral hemorrhagecerebral herniaheadachedazzlenauseavomitHypopsiaretinal detachment Cortical blindnessDysesthesiaConfusion of thinking Eclampsiaconvulsion comabrain：Vasospasmpermeabilitykidney renal vasospasmrenal blood flow glomerular filtra

6、tion rate pathology ：Glomerular expansion swollen vascular endothelial cellcellulose depositionrenocortical necrosisrenal irreversible damageclinical manifestation ：albuminuriahypoproteinemiarenal dysfunction creatinine urea nitrogen uric acid oliguria renal failure liverhepatic vasospasm;hepatic is

7、chemia;hepatic edema liver enlargement; hepatic dysfunction elevated liver enzymejaundice hypoproteinemia coagulation function changed severe：Periportal necrosishepatic subcapsularhematomahepatorrhexis HELLP symdrome:Elevated hepatic enzymesDecreased blood plateletCardiovascular System Blood Pressur

8、e Vasospasm Vascular Resistance Cardiac Load heart failure vasospasm Myocardial IschemiaInterstitial EdemaSpotty Necrosis pulmonary vasospasm Pulmonary Hypertension Pulmonary EdemaOliguriawater-sodium retentionRelative Blood Volume ExcessIatrogenic Blood Volume ExcessHigh burdenPoor abilityblood sys

9、tem Relative hypovolemiaAnemiaDecreased blood plateletHypercoagulability blood clotting factorplacenta-fetusplacenta Placental hypoperfusionSpiral arteries sclerosis Placental InfarctionPlacental AbruptionPlacental function decreasesfetus IUGRfetal distressoligohydramniosfetal death PathophysiologyB

10、rainHeadache; visual blurred; coma; herniaKidneyRenal function compromised; proteinuria; renal failureLiverPersistent upper right abdominal pain; Elevated enzyme; jaundice; hematoma; ruptureSystematic diseasePathophysiologyCardiovascular systemLow output- high resistance; myocardial ischemia; pulmon

11、ary hypertension; edema; heart failureBloodLow volume; hypercoagulability; DICPathophysiologyUterus and PlacentaLow perfusion; placental atherosclerosisPlacental infarction; placental abruption; fetal growth retardation; fetal deathHigh risk factorsPrimipara40yMultiple pregnancyHypertensionChronic n

12、ephritisMalnutritionPoor social statusDiabetesAnti-phospholipid syndromeAngiotensin gene T235 (+)EtiologyGenetic susceptibility hypothesisImmune maladaptation hypothesisPlacental ischemia hypothesisOxidative stress hypothesis Genetic susceptibilityImmune maladaptationPlacental ischemiaOxidativestres

13、sAbnormal placentalThe change of cytokinePEdevelopmentEndothelium injuredDICComplicationsGenetic susceptibility hypothesisHypertensionImmune maladaptation hypothesisMultiple gestationAbortion and blood transfusionOvum and sperm donationPlacental ischemia hypothesis40% total spiral artery area compar

14、ed to normal pregnancyEndothelial cell injuryOxidative stress hypothesisOxidative stress reactionEndothelial cell injuryCategory and clinical manifestationGestational hypertension PreeclampsiaEclampsia Chronic hypertensionPreeclampsia superimposed on chronic hypertensionclinical features typical : h

15、ypertension、albuminuria、edemauntypical ：asymptomatic severe：nausea、vomitheadache、dazzleconvulsion 、comachest distress 、palpitation Gestational Hypertension Definition Hypertension occurs 20 weeks after gestation and recovers 12 weeks postpartumSBP=140mmHgDBP =90mmHgDiagnosed only after deliveryPreec

16、lampsiaHypertention occurs 20 weeks after gestation BP=140/90mmHgProteinuria Proteinuria 300mg/24h Urine protein （+）Other symptomsHeadache, visual blurringUpper abdominal painSevere preeclampsiaAt least one of the following features：Central nervous system abnormalities Hepatic subcapsular hematoma /

17、 hepatorrhexisHepatocyte injury :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 / oligohy

18、dramniosSevere preeclampsia complicationsHepatic subcapsularhematoma Early-onset preeclampsia : 20.5mol/LElevated serum level of Liver enzymesAST70u/L, or 3SDLDH600u/LLow PlateletsPLC100*109/LHELLPSevere preeclampsia ：One abnormalities 6%Two abnormalities 12%Three abnormalities10%20 gw seldom occur1

19、/3 occur after delivery80% diagnosed prenatallyHELLPclinical diagnosis Might be asymptomatic pain in the right upper abdomen80% weight gain or severe edema 50-60%20% cases 140/90 mmHg6% cases without proteinuriaSome investigatiors regard HELLP syndrome as an entirely distinct disease entity from pre

20、eclampsiaClassification of HELLPBy degree of thrombocytopenia：100,000/mm3Not widely acceptedPathogenesis and epidemic characteristics of HELLP core mechanismendothelial injuryintravascular coagulation dysfunctionpredisposing factorsthe whitemultipara elder pregnant womenHELLP-mortalityMaternal 0-24%

21、hepatorrhexisDICAcute renal failurethrombosiscerebrovascular accidentsPerinatal 7.7-60%Premature deliveryIUGRplacental abruption Eclampsiaprocess：tonusconvulsionsleepinesscoma Occurrenceprenatalintrapartumpostpartum Chronic Hypertension during PregnancyHypertension before pregnancy or Hypertension b

22、efore 20 weeks gestationalUnrelieved 12 weeks postpartumPoor fetal outcomePerinatal mortality 3 times Placental abruption 2 times FGR, preterm birth preeclampsia superimposed upon chronic hypertensionChronic Hypertension Before 20 gestational weeksPersist 12 weeks postpartumProteinuriaBefore 20wAfte

23、r 20w; with higher BP; thrombocytopeniaDifferential diagnosisChronic nephritis complicating pregnancyRenal dysfunctionSeizure caused by other reasonsManagementPrincipleSedationAnti-spasmAnti-hypertensionDiuresisTerminate pregnancy timelyManagementCommon treatmentRestMonitoringOxygen inhalationDiet:

24、salt restriction only for anasarca patientsManagementSedationDiazepamHibernation drugsPethidineChlorpromazinePromethazineManagementAnti-spasmFirst line treatment for pre-eclampsia and eclampsiaMgSO4 MechanismRegimen 25-30g/dLoading dose: 25% MgSO4 10ml +10%GS 20ml iv 5-10min25% MgSO4 60ml +5%GS 500m

25、l ivgtt 1-2g/h25% MgSO4 20ml +2%lidocaine 2ml im. 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 deto