子痫和先兆子痫麻醉处理.pptVIP

Preeclampsia and Eclampsia: Anesthetic Management Anita M. Backus, MD Assistant Clinical Professor Director of Obstetric Anesthesia UCLA Medical Center Los Angeles, California Preeclampsia: Epidemiology Incidence widely quoted at 5-7% varies greatly depending on the population Remains a major cause of maternal mortality U.S. (1987-90) PIH: 17.6% of mat. deaths, 3rd leading cause Preeclampsia (9.4%); eclampsia (7.4%) Mexico (1990-95) PIH: 26% of deaths (2204), 2nd leading cause In the most developed and medically advanced region: 46% of deaths Hypertension during Pregnancy: Classification Pregnancy-induced hypertension Hypertension without proteinuria/edema Preeclampsia mild severe Eclampsia Coincidental HTN: preexisting or persistent Pregnancy-aggravated HTN superimposed preeclampsia superimposed eclampsia Transient HTN: occurs in 3rd trimester, mild Preeclampsia: Definition Hypertension 140/90 relative ? no longer considered diagnostic Proteinuria 300 mg/24 hours or ? 1+ on urine dipstick not mandatory for diagnosis; may occur late Edema (non-dependent) so common difficult to quantify it is rarely evoked to make or refute the diagnosis Criteria for Severe Preeclampsia SBP 160 mm Hg DBP 110 mm Hg Proteinuria 5 g/24° or 3-4+ on dipstick Oliguria 500 cc/24° ? serum creatinine Pulmonary edema or cyanosis CNS symptoms (HA, vision changes) Abdominal (RUQ) pain Any feature of HELLP hemolysis ? liver enzymes thrombocytopenia IUGR or oligohydramnios Preeclampsia: Risk Factors Nulliparity (or, more correctly, primipaternity) Chronic renal disease Angiotensinogen gene T235 Chronic hypertension Antiphospholipid antibody syndrome Multiple gestation Family or personal history of preeclampsia Age 40 years African-American race Diabetes mellitus Etiology and Prevention Etiology is unknown. Many theories: genetic immunologic dietary deficiency (calcium, magnesium, zinc) supplementation has not proven effective placental source (ischemia) Etiology and Prevention A major un