先兆子痫和子痫患者的麻醉管理课件

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1、PreeclampsiaandEclampsia:AnestheticManagementAnitaM.Backus,MDAssistantClinicalProfessorDirectorofObstetricAnesthesiaUCLAMedicalCenterLosAngeles,Californiawww.anaesthesia.co.inanaesthesia.co.in@gmail.comPreeclampsia:EpidemiologyIncidencewidelyquotedat5-7%variesgreatlydepe

2、ndingonthepopulationRemainsamajorcauseofmaternalmortalityU.S.(1987-90)PIH:17.6%ofmat.deaths,3rdleadingcausePreeclampsia(9.4%);eclampsia(7.4%)Mexico(1990-95)PIH:26%ofdeaths(2204),2ndleadingcauseInthemostdevelopedandmedicallyadvancedregion:46%ofdeathsHypertensionduringPreg

3、nancy:ClassificationPregnancy-inducedhypertensionHypertensionwithoutproteinuria/edemaPreeclampsiamildsevereEclampsiaCoincidentalHTN:preexistingorpersistentPregnancy-aggravatedHTNsuperimposedpreeclampsiasuperimposedeclampsiaTransientHTN:occursin3rdtrimester,mildPreeclamps

4、ia:DefinitionHypertension>140/90relativenolongerconsidereddiagnosticProteinuria>300mg/24hoursor1+onurinedipsticknotmandatoryfordiagnosis;mayoccurlateEdema(non-dependent)socommon&difficulttoquantifyitisrarelyevokedtomakeorrefutethediagnosisCriteriaforSeverePreeclampsiaS

5、BP>160mmHgDBP>110mmHgProteinuria>5g/24°or3-4+ondipstickOliguria<500cc/24°serumcreatininePulmonaryedemaorcyanosisCNSsymptoms(HA,visionchanges)Abdominal(RUQ)painAnyfeatureofHELLPhemolysisliverenzymesthrombocytopeniaIUGRoroligohydramniosPreeclampsia:RiskFactorsNulliparity

6、(or,morecorrectly,primipaternity)ChronicrenaldiseaseAngiotensinogengeneT235ChronichypertensionAntiphospholipidantibodysyndromeMultiplegestationFamilyorpersonalhistoryofpreeclampsiaAge>40yearsAfrican-AmericanraceDiabetesmellitusEtiologyandPreventionEtiologyisunknown.Manyt

7、heories:geneticimmunologicdietarydeficiency(calcium,magnesium,zinc)supplementationhasnotproveneffectiveplacentalsource(ischemia)EtiologyandPreventionAmajorunderlyingdefectisarelativedeficiencyofprostacyclinvs.thromboxaneNormally(non-preeclamptic)thereisan8-10foldinprost

8、acyclinwithasmallerinthromboxaneprostacyclinsalutatoryeffectsdominatevasodilation,plateletaggregation