妊娠高血压疾病.ppt

HypertensionDisordersComplicatingPregnancy,妊娠期高血压疾病,.,HypertensiveDisorderscomplicatingPregnancy,GestationalHypertension,Preeclampsia,PreeclampsiaSuperimposedonChronicHypertension,ChronicHypertension,Eclampsia,AGroupofRelatedDiseases,Characteristics,Systemicsmallarteriesspasm,Endothelialcellinjury,Hypertension,Proteinuria,Multipleorgansdysfunction,Convulsion,Maternalmortality,Fetalmortality,GestationalHypertension;Chronichypertension,Eclampsia,Preeclampsia;PreeclampsiaSuperimposedonChronicHypertension,Hypertensiondisorderscomplicatingpregnancy,PathophysiologyCategoryandclinicalmanifestationDiagnosisanddifferentialdiagnosisManagementandprevention,病理生理,临床表现,诊断,治疗,Epidemiology,Incidence：6-9%Preeclampsia-eclampsia：70%ChronicHypertension：30%Eclampsia0.5%-1%China1.0%Overseas0.5%ReflectionofmedicallevelThesecondcauseofmaternaldeath(20%)Causeofprematuredelivery（10%）Unknownorigin,Pathophysiology,BasicpathologicalchangesSpasmofsystemicsmallarteriesVascularendothelialcellinjury,Pathophysiology,fluid,protein,HypertensionEdemaProteinuriaHemoconcentration,Smallarterialspasm,Endothelialcellinjury,Multipleorgansdysfunction,IschemiaEdemamalfunction,SystemicDisease,Brain,HydrocephalusHyperemia/ischemiaThrombosiscerebralhemorrhagecerebralhernia,headachedazzlenauseavomit,HypopsiaretinaldetachmentCorticalblindnessDysesthesiaConfusionofthinking,Eclampsiaconvulsioncoma,brain：Vasospasmpermeability,kidney,renalvasospasm,renalbloodflow,glomerularfiltrationrate,pathology：Glomerularexpansionswollenvascularendothelialcellcellulosedepositionrenocorticalnecrosisrenalirreversibledamage,clinicalmanifestation：albuminuriahypoproteinemiarenaldysfunctioncreatinineureanitrogenuricacidoliguriarenalfailure,liver,hepaticvasospasm;hepaticischemia;hepaticedema,liverenlargement;hepaticdysfunctionelevatedliverenzymejaundicehypoproteinemiacoagulationfunctionchanged,severe：Periportalnecrosishepaticsubcapsularhematomahepatorrhexis,HELLPsymdrome:ElevatedhepaticenzymesDecreasedbloodplatelet,CardiovascularSystem,BloodPressure,Vasospasm,VascularResistance,CardiacLoad,heartfailure,vasospasm,MyocardialIschemiaInterstitialEdemaSpottyNecrosis,pulmonaryvasospasm,PulmonaryHypertension,PulmonaryEdema,Oliguria,water-sodiumretention,RelativeBloodVolumeExcess,IatrogenicBloodVolumeExcess,Highburden,Poorability,bloodsystem,RelativehypovolemiaAnemiaDecreasedbloodplateletHypercoagulabilitybloodclottingfactor,placenta-fetus,placentaPlacentalhypoperfusionSpiralarteriessclerosisPlacentalInfarctionPlacentalAbruptionPlacentalfunctiondecreases,fetusIUGRfetaldistressoligohydramniosfetaldeath,Pathophysiology,BrainHeadache;visualblurred;coma;herniaKidneyRenalfunctioncompromised;proteinuria;renalfailureLiverPersistentupperrightabdominalpain;Elevatedenzyme;jaundice;hematoma;rupture,Systematicdisease,Pathophysiology,CardiovascularsystemLowoutput-highresistance;myocardialischemia;pulmonaryhypertension;edema;heartfailureBloodLowvolume;hypercoagulability;DIC,Pathophysiology,UterusandPlacentaLowperfusion;placentalatherosclerosisPlacentalinfarction;placentalabruption;fetalgrowthretardation;fetaldeath,Highriskfactors,Primipara40yMultiplepregnancyHypertensionChronicnephritisMalnutritionPoorsocialstatusDiabetes,Anti-phospholipidsyndromeAngiotensingeneT235(+),Etiology,GeneticsusceptibilityhypothesisImmunemaladaptationhypothesisPlacentalischemiahypothesisOxidativestresshypothesis,Geneticsusceptibility,Immunemaladaptation,Placentalischemia,Oxidativestress,Abnormalplacental,Thechangeofcytokine,PE,development,Endotheliuminjured,DIC,Complications,Geneticsusceptibilityhypothesis,Hypertension,Immunemaladaptationhypothesis,MultiplegestationAbortionandbloodtransfusionOvumandspermdonation,Placentalischemiahypothesis,40%totalspiralarteryareacomparedtonormalpregnancyEndothelialcellinjury,Oxidativestresshypothesis,Oxidativestressreaction,Endothelialcellinjury,Categoryandclinicalmanifestation,GestationalhypertensionPreeclampsiaEclampsiaChronichypertensionPreeclampsiasuperimposedonchronichypertension,clinicalfeatures,typical:hypertension、albuminuria、edemauntypical：asymptomaticsevere：nausea、vomitheadache、dazzleconvulsion、comachestdistress、palpitation,GestationalHypertension,DefinitionHypertensionoccurs20weeksaftergestationandrecovers12weekspostpartumSBP=140mmHgDBP=90mmHgDiagnosedonlyafterdelivery,Preeclampsia,Hypertentionoccurs20weeksaftergestationBP=140/90mmHgProteinuriaProteinuria300mg/24hUrineprotein（+）OthersymptomsHeadache,visualblurringUpperabdominalpain,Severepreeclampsia,Atleastoneofthefollowingfeatures：CentralnervoussystemabnormalitiesHepaticsubcapsularhematoma/hepatorrhexisHepatocyteinjury:GPTBloodpressure：SBP160mmHg，orDBP110mmHgThrombocytopenia:1