妊娠期高血压疾病是全世界范围内导致孕产妇和围产儿死亡的重要原因之一,全球发病率在2%~8%。因其影响范围广泛、不良妊娠结局发生率高以及高昂的医疗花费,妊娠期高血压疾病一直是全球产科医生关注的重点。2019年美国妇产科医师学会(Ame...妊娠期高血压疾病是全世界范围内导致孕产妇和围产儿死亡的重要原因之一,全球发病率在2%~8%。因其影响范围广泛、不良妊娠结局发生率高以及高昂的医疗花费,妊娠期高血压疾病一直是全球产科医生关注的重点。2019年美国妇产科医师学会(American College of Obstetricians and Gynecologists,ACOG)发布了'妊娠期高血压和子痫前期指南2019版”[1],本指南主要针对妊娠期高血压和子痫前期,在2013版指南[2]的基础上加入了最近几年该领域的研究进展,包括疾病的背景信息和处理建议两部分内容。现针对该指南第一部分内容解读如下。展开更多
妊娠期高血压疾病(hypertensive disorders in pregnancy)是严重威胁母儿健康和生命的产科常见病症,造成的孕产妇死亡约占妊娠相关死亡总数的10%~16%,不过有一半相关孕产妇死亡可以避免。孕产妇死亡事件和重症案例可以发生在各级医疗机...妊娠期高血压疾病(hypertensive disorders in pregnancy)是严重威胁母儿健康和生命的产科常见病症,造成的孕产妇死亡约占妊娠相关死亡总数的10%~16%,不过有一半相关孕产妇死亡可以避免。孕产妇死亡事件和重症案例可以发生在各级医疗机构,而且存在的诊疗问题涉及各个环节并有其相似性。需解决的关键问题就是提高临床认知、临床思维和临床处置的实践能力。展开更多
目的应用LiDCO-rapid监测仪管理子痫前期产妇的产程,比较分娩镇痛前后的血流动力学变化及母婴安全。方法选择2017年3-11月于本院分娩的初产、单胎子痫前期产妇64例,年龄22~35岁,体重55~85 kg,ASAⅡ或Ⅲ级。其中行分娩镇痛的32例产妇纳...目的应用LiDCO-rapid监测仪管理子痫前期产妇的产程,比较分娩镇痛前后的血流动力学变化及母婴安全。方法选择2017年3-11月于本院分娩的初产、单胎子痫前期产妇64例,年龄22~35岁,体重55~85 kg,ASAⅡ或Ⅲ级。其中行分娩镇痛的32例产妇纳入分娩镇痛组(LA组),由于产科因素、麻醉禁忌或产妇拒绝椎管内麻醉而未实施分娩镇痛的32例产妇纳入对照组(C组)。LA组在出现子宫规律收缩后进行分娩镇痛,并且持续应用镇痛泵至第一产程结束。产程中应用常规监护仪和LiDCO-rapid监测,记录镇痛前(T0)、镇痛后10 min(T1)、30 min(T2)、60 min(T3)、宫口开全(T4)时的MAP、心输出量(CO)及外周血管阻力(SVR);记录第一产程、第二产程时间;记录缩宫素、降压药物的使用情况;记录分娩方式、发生子痫和产后出血的情况;记录新生儿出生后1.5和10 min Apgar评分。结果与C组比较,LA组第一产程时间、第二产程时间明显延长(P<0.05),均在正常范围内;T1时MAP明显降低(P<0.05);T2-T4时MAP、CO和SVR明显降低(P<0.05);缩宫素使用率明显升高(P<0.05);降压药物使用率和产钳助产率明显降低(P<0.05)。LA组新生儿出生后1 min Apgar评分明显低于C组(P<0.05)。两组均无一例发生子痫及产后出血。结论分娩镇痛可有效改善子痫前期产妇产程中的血流动力学状态,降低阴道试产的危险性。LiDCO-rapid帮助产科医师和麻醉科医师了解产妇病理生理变化,并在分娩过程中及时调整治疗。展开更多
Background Early and late-onset preeclampsia is thought to be different disease entities. This study aimed to determine the effects of early-onset preeclampsia-like symptoms on feto-placental outcomes and the adverse ...Background Early and late-onset preeclampsia is thought to be different disease entities. This study aimed to determine the effects of early-onset preeclampsia-like symptoms on feto-placental outcomes and the adverse impacts of various factors on placental and fetal growth and development at different gestational stages in a mouse model. Methods Pregnant C57BL/6J mice were divided into control and preeclampsia （PE） groups, and injected subcutaneously with the nitric oxide synthase inhibitor L-arginine methyl ester （L-NAME） 50 mg·kg^-1·d^-1. The PE group was divided into early-, mid- and late-PE groups with L-NAME injections starting on days 7, 11 and 16 of pregnancy, respectively. Corresponding control groups were injected with saline at the same time points. Blood pressure was measured until days 14 and 18, when the fetuses and placentas were removed under anesthesia. Blood pressure, urinary protein, and fetal and placental conditions were analyzed. Results Blood pressure and urinary protein increased following L-NAME injection. The fetal survival rate and fetal weight were reduced and the fetal absorption rate was increased in the early-PE group on days 14 and 18 of pregnancy, compared with the control group. There were no significant differences in these parameters between the late-PE group and the respective control group. Placental weights in the early- and mid-PE groups were significantly reduced at days 14 and 18 of pregnancy compared with the control groups, but there was no significant difference in placental weight between the late-PE group and the respective control group. Morphologic examination of placentas from the early- and mid-PE groups showed varying degrees of fibrinoid necrosis and villous interstitial edema, but no significant pathologic changes were found in the placentas from the late-PE or control groups. Conclusion Preeclampsia-like symptoms occurring during the early stage of pregnancy are more likely to affect placental and fetal development, whereas late onset preeclampsia-li展开更多
文摘妊娠期高血压疾病是全世界范围内导致孕产妇和围产儿死亡的重要原因之一,全球发病率在2%~8%。因其影响范围广泛、不良妊娠结局发生率高以及高昂的医疗花费,妊娠期高血压疾病一直是全球产科医生关注的重点。2019年美国妇产科医师学会(American College of Obstetricians and Gynecologists,ACOG)发布了'妊娠期高血压和子痫前期指南2019版”[1],本指南主要针对妊娠期高血压和子痫前期,在2013版指南[2]的基础上加入了最近几年该领域的研究进展,包括疾病的背景信息和处理建议两部分内容。现针对该指南第一部分内容解读如下。
文摘妊娠期高血压疾病(hypertensive disorders in pregnancy)是严重威胁母儿健康和生命的产科常见病症,造成的孕产妇死亡约占妊娠相关死亡总数的10%~16%,不过有一半相关孕产妇死亡可以避免。孕产妇死亡事件和重症案例可以发生在各级医疗机构,而且存在的诊疗问题涉及各个环节并有其相似性。需解决的关键问题就是提高临床认知、临床思维和临床处置的实践能力。
文摘目的应用LiDCO-rapid监测仪管理子痫前期产妇的产程,比较分娩镇痛前后的血流动力学变化及母婴安全。方法选择2017年3-11月于本院分娩的初产、单胎子痫前期产妇64例,年龄22~35岁,体重55~85 kg,ASAⅡ或Ⅲ级。其中行分娩镇痛的32例产妇纳入分娩镇痛组(LA组),由于产科因素、麻醉禁忌或产妇拒绝椎管内麻醉而未实施分娩镇痛的32例产妇纳入对照组(C组)。LA组在出现子宫规律收缩后进行分娩镇痛,并且持续应用镇痛泵至第一产程结束。产程中应用常规监护仪和LiDCO-rapid监测,记录镇痛前(T0)、镇痛后10 min(T1)、30 min(T2)、60 min(T3)、宫口开全(T4)时的MAP、心输出量(CO)及外周血管阻力(SVR);记录第一产程、第二产程时间;记录缩宫素、降压药物的使用情况;记录分娩方式、发生子痫和产后出血的情况;记录新生儿出生后1.5和10 min Apgar评分。结果与C组比较,LA组第一产程时间、第二产程时间明显延长(P<0.05),均在正常范围内;T1时MAP明显降低(P<0.05);T2-T4时MAP、CO和SVR明显降低(P<0.05);缩宫素使用率明显升高(P<0.05);降压药物使用率和产钳助产率明显降低(P<0.05)。LA组新生儿出生后1 min Apgar评分明显低于C组(P<0.05)。两组均无一例发生子痫及产后出血。结论分娩镇痛可有效改善子痫前期产妇产程中的血流动力学状态,降低阴道试产的危险性。LiDCO-rapid帮助产科医师和麻醉科医师了解产妇病理生理变化,并在分娩过程中及时调整治疗。
基金This work was supported by a grant from the National Natural Science Foundation of China （No. 30840088）.
文摘Background Early and late-onset preeclampsia is thought to be different disease entities. This study aimed to determine the effects of early-onset preeclampsia-like symptoms on feto-placental outcomes and the adverse impacts of various factors on placental and fetal growth and development at different gestational stages in a mouse model. Methods Pregnant C57BL/6J mice were divided into control and preeclampsia （PE） groups, and injected subcutaneously with the nitric oxide synthase inhibitor L-arginine methyl ester （L-NAME） 50 mg·kg^-1·d^-1. The PE group was divided into early-, mid- and late-PE groups with L-NAME injections starting on days 7, 11 and 16 of pregnancy, respectively. Corresponding control groups were injected with saline at the same time points. Blood pressure was measured until days 14 and 18, when the fetuses and placentas were removed under anesthesia. Blood pressure, urinary protein, and fetal and placental conditions were analyzed. Results Blood pressure and urinary protein increased following L-NAME injection. The fetal survival rate and fetal weight were reduced and the fetal absorption rate was increased in the early-PE group on days 14 and 18 of pregnancy, compared with the control group. There were no significant differences in these parameters between the late-PE group and the respective control group. Placental weights in the early- and mid-PE groups were significantly reduced at days 14 and 18 of pregnancy compared with the control groups, but there was no significant difference in placental weight between the late-PE group and the respective control group. Morphologic examination of placentas from the early- and mid-PE groups showed varying degrees of fibrinoid necrosis and villous interstitial edema, but no significant pathologic changes were found in the placentas from the late-PE or control groups. Conclusion Preeclampsia-like symptoms occurring during the early stage of pregnancy are more likely to affect placental and fetal development, whereas late onset preeclampsia-li
