课件：妊娠内科合并症.ppt

Eclampsia 子痫 Appearance of seizures in a patient with preeclampsia先兆子痫的患者发生抽搐 Etiology uncertain病因不清 cerebral edema, ischemia possible causes脑水肿、缺血可能是原因 BP often significantly elevated, but in 20% can be normal (diastolic 90)血压常升高，但20%的患者并不高（舒张压90mmHg) Can occur before, during or after delivery可发生于分娩前、分娩时、或产后 Seizure Management抽搐的处理 Avoid anticonvulsant polypharmacy 避免抽搐时使用多种药物 Protect airway to minimize aspiration 保护气道以减少吸入 Prevent maternal injury 预防母亲的损伤 Give MgSO4 to control the convulsions 予以硫酸镁控制抽搐 When stable, plan for delivery 当病情稳定，计划分娩 HELLP Syndrome HELLP综合征 Atypical presentation of severe preeclampsia重度先兆子痫的不典型表现 Acronym HELLP: 首字缩写代表代表 Hemolysis溶血 Elevated Liver enzymes肝酶升高 Low Platelets血小板降低 Clinical Presentation of HELLP HELLP的临床表现 Extremely variable极大的变异性 Common findings:常有的发现是 RUQ pain, epigastric pain, nausea, and vomiting右上腹痛、上腹痛、恶心、呕吐 85% hypertensive85%有高血压 Time of diagnosis诊断时间 2/3 antepartum, 1/3 postpartum 2/3在产前，1/3产后 Mid-second trimester to several days postpartum孕中期的中间至产后数日 Differential Diagnosis of HELLP HELLP的鉴别诊断 Biliary colic, cholecystitis胆绞痛、胆囊炎 Hepatitis肝炎 Gastroesophageal reflux胃食道返流 Gastroenteritis胃肠炎 Pancreatitis胰腺炎 Ureteral calculi or pyelonephritis输尿管结石或肾盂肾炎 ITP or TTP特发性血小板减少性紫癫或血栓性血小板减少性紫癫 Laboratory Findings in HELLP HELLP 的化验所见 Hemolysis溶血 Abnormal peripheral smear异常的周缘血涂片 Total bilirubin 总胆红素 1.2 mg/dl LDH 600 IU/L Liver enzymes肝酶 AST (SGOT) 70 IU/L Platelet count血小板计数 100,000 per mm3 Used to classify severity用以判断严重性 THANK YOU SUCCESS * * 可编辑 Management of HELLP HELLP的处理 Similar to severe preeclampsia:同于子痫前期 Stabilize mother Evaluate fetus for compromise Determine optimal timing/route of delivery Use CEFM and manage BP and fluid status 稳定母亲 评估胎儿是否受损 确定合适的分娩时间及方式 使用连续胎心电子监护及处理血压及液体的状况 All women should receive MgSO4 while symptomatic or in labor 所有的孕妇在有症状或临产时都使用硫酸镁 HELLP: New Treatments新治疗 Dexamethasone 10 mg IV q12h when platelets 100,000血小板100000时候静脉地塞米松10mg每12h Platelets for active bleeding, or if 20,000 活动性出血或