4妊娠高血压疾病陈晓军.ppt

Hypertension Disorders Complicating Pregnancy 妊娠期高血压疾病 Characteristics Hypertension disorders complicating pregnancy Pathophysiology Category and clinical manifestation Diagnosis and differential diagnosis Management and prevention Pathophysiology Pathophysiology Brain Headache; visual blurred; coma; hernia Kidney Renal function compromised; proteinuria; renal failure Liver Persistent upper right abdominal pain; Elevated enzyme; jaundice; hematoma; rupture Pathophysiology Cardiovascular system Low output- high resistance; myocardial ischemia; pulmonary hypertension; edema; heart failure Blood Low volume; hypercoagulability; DIC Pathophysiology Uterus and Placenta Low perfusion; placental atherosclerosis Placental infarction; placental abruption; fetal growth retardation; fetal death Etiology Genetic susceptibility hypothesis Immune maladaptation hypothesis Placental ischemia hypothesis Oxidative stress hypothesis Genetic susceptibility hypothesis Immune maladaptation hypothesis Multiple gestation Abortion and blood transfusion Ovum and sperm donation Placental ischemia hypothesis 40% total spiral artery area compared to normal pregnancy Endothelial cell injury Oxidative stress hypothesis Category and clinical manifestation Gestational hypertension Preeclampsia Eclampsia Chronic hypertension Preeclampsia superimposed on chronic hypertension Differential diagnosis Chronic nephritis complicating pregnancy Renal dysfunction Seizure caused by other reasons Management Principle Sedation Anti-spasm Anti-hypertension Diuresis Terminate pregnancy timely Management Common treatment Rest Monitoring Oxygen inhalation Diet: salt restriction only for anasarca patients Management Sedation Diazepam Hibernation drugs Pethidine Chlorpromazine Promethazine Management Anti-spasm First line treatment for pre-eclampsia and eclampsia MgSO4 Mechanism Regimen ≥25-30g/d Loading dose: 25% MgSO4 10ml +10%GS 20ml iv 5-10min 25% MgSO4 60ml +5%GS 500ml ivgtt 1-2g/h 25% MgSO4 20ml +2%li