妊娠期期高血压疾病 中英版课件.pptVIP

第四节 妊娠期高血压疾病Hypertensive States of Pregnancy 妊娠期高血压疾病(hypertensive states of pregnancy)包括： 妊娠期高血压(gestational hypertension) 子痫前期(preeclampsia) 子痫(eclampsia) 慢性高血压并发子痫前期( chronic hypertension with superimposed preeclampsia) 妊娠合并慢性高血压(chronic hypertension complicating pregnancy) 本病以高血压、蛋白尿、水肿为主要症状，可伴有全身多器官功能损害或衰竭，重者可出现抽搐、昏迷甚至死亡，严重危害母婴健康，是孕产妇及围生儿死亡的主要原因。 hypertensive states of pregnancy：The main symptoms are hypertension, proteinuria, edema, accompanied by multiple organ disfunction or failure, seriously to be possible to have twitches, the stupor even maternal infant to die. http://www.health.am/pregnancy/hypertensive-states-of-pregnancy/ 【病因pathogenesis】 可能与异常滋养细胞侵入子宫肌层、免疫机制、血管内皮细胞受损、遗传因素、营养缺乏、胰岛素抵抗等有关。 pathogenesis: Some theories include (1) endothelial cell injury, (2) rejection phenomenon (insufficient production of blocking antibodies), (3) compromised placental perfusion, (4) altered vascular reactivity, (5) imbalance between prostacyclin and thromboxane, (6) decreased glomerular filtration rate with retention of salt and water, (7) decreased intravascular volume, (8) increased central nervous system irritability, (9) disseminated intravascular coagulation, (10) uterine muscle stretch (ischemia), (11) dietary factors, and (12) genetic factors. (2)子痫前期 preeclampsia 轻度：BP≥140/90mmHg，孕20周以后出现；尿蛋白≥300mg/24h或（+）。可伴有上腹不适、头痛、视力模糊等症状。 Preeclampsia is hypertension associated with proteinuria and edema, occurring primarily in nulliparas after the 20th gestational week and most frequently near term. There are 2 categories of preeclampsia, mild and severe. mild preeclampsia is defined as the following: (1) HTN (BP≥140/90mmHg); (2) proteinuria exceeding 0.3 g in a 24-hour period or 1-2+ on dipstick testing;(3) Edema (hands or/and face) without other signs/symptoms (2)子痫前期 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；持续性头痛或其它脑神经或视觉障碍；持续性上腹不适。 Severe preeclampsia is defined as the following: (1) blood pressure gr