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(hù)理本科《母嬰護(hù)理學(xué)》紹興文理學(xué)院

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.

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(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.http://www.health.am/pregnancy/hypertensive-states-of-pregnancy/【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,

Hypertension

andRenaldiseases；⑤malnutrition；Obesity；⑥lowsocioeconomicstatus⑦M(jìn)ultiplegestation,polyhydramnios；⑧Familyhistoryofhypertension；【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.【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)【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(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.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(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

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。(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

(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。definedasbloodpressureequaltoorgreaterthan140/90mmHgbeforeconceptionorbefore

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