常见妊娠高血压疾病(专家解读)---陈晓军课件.ppt

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1、HypertensionDisordersComplicatingPregnancy妊娠期高血压疾病HypertensiveDisorderscomplicatingPregnancyGestationalHypertensionPreeclampsiaPreeclampsiaSuperimposedonChronicHypertensionChronicHypertensionEclampsiaAGroupofRelatedDiseasesCharacteristicsSystemicsmallarteriesspasmEndothelialcellin

2、juryHypertensionProteinuriaMultipleorgansdysfunctionConvulsionMaternalmortalityFetalmortalityGestationalHypertension;ChronichypertensionEclampsiaPreeclampsia;PreeclampsiaSuperimposedonChronicHypertensionHypertensiondisorderscomplicatingpregnancyPathophysiologyCategoryandclinicalma

3、nifestationDiagnosisanddifferentialdiagnosisManagementandprevention病理生理临床表现诊断治疗EpidemiologyIncidence：6-9%Preeclampsia-eclampsia：70%ChronicHypertension：30%Eclampsia0.5%-1%China1.0%Overseas0.5%ReflectionofmedicallevelThesecondcauseofmaternaldeath(20%)Causeofprematuredelivery（10%）Unk

4、nownoriginPathophysiologyBasicpathologicalchangesSpasmofsystemicsmallarteriesVascularendothelialcellinjuryPathophysiologyfluidproteinHypertensionEdemaProteinuriaHemoconcentrationSmallarterialspasmEndothelialcellinjuryMultipleorgansdysfunctionIschemiaEdemamalfunctionSystemicDisease

5、BrainHydrocephalusHyperemia/ischemiaThrombosiscerebralhemorrhagecerebralherniaheadachedazzlenauseavomitHypopsiaretinaldetachmentCorticalblindnessDysesthesiaConfusionofthinkingEclampsiaconvulsioncomabrain：Vasospasmpermeability↑kidneyrenalvasospasmrenalbloodflow↓glomerularfiltration

6、rate↓pathology：Glomerularexpansionswollenvascularendothelialcellcellulosedepositionrenocorticalnecrosis——renalirreversibledamageclinicalmanifestation：albuminuriahypoproteinemiarenaldysfunctioncreatinineureanitrogenuricacidoliguriarenalfailureliverhepaticvasospasm;hepaticischemia;h

7、epaticedemaliverenlargement;hepaticdysfunctionelevatedliverenzymejaundicehypoproteinemiacoagulationfunctionchangedsevere：PeriportalnecrosishepaticsubcapsularhematomahepatorrhexisHELLPsymdrome:ElevatedhepaticenzymesDecreasedbloodplateletCardiovascularSystemBloodPressure↑VasospasmVa

8、scularResistance↑CardiacLoad↑hear