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中华肾病研究电子杂志 ›› 2015, Vol. 04 ›› Issue (04) : 192 -195. doi: 10.3877/cma.j.issn.2095-3216.2015.04.006

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妊娠期高血压疾病的处理
何娅妮1,(), 刘佳睿1   
  1. 1. 400042 重庆,第三军医大学大坪医院肾内科
  • 出版日期:2015-08-28
  • 通信作者: 何娅妮

Management of hypertensive disorders in pregnancy

Yani He1,(), Jiarui Liu1   

  1. 1. Department of Nephrology, Daping Hospital, Research Institute of Surgery, Third Military Medical University, Chongqing 400042, China
  • Published:2015-08-28
  • Corresponding author: Yani He
  • About author:
    Corresponding author: He Yani, Email:
引用本文:

何娅妮, 刘佳睿. 妊娠期高血压疾病的处理[J]. 中华肾病研究电子杂志, 2015, 04(04): 192-195.

Yani He, Jiarui Liu. Management of hypertensive disorders in pregnancy[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2015, 04(04): 192-195.

妊娠期高血压疾病(HDP)是妊娠期常见的以高血压、肾功能损害、神经系统症状为主要表现的严重临床综合征,是导致妊娠期死亡的首要原因。根据2013美国妇产科医师协会指南HDP可分为妊娠期高血压、子痫前期-子痫、慢性高血压及慢性高血压并发子痫前期。妊娠期血压≥160/110 mmHg应给予降压治疗。钙离子拮抗剂、交感神经抑制剂应作为降压药物的首选,由于肾素血管紧张素受体抑制剂的潜在致畸性不建议早期使用。单纯子痫前期患者可给予期待治疗,包括降压、对症和营养支持等。妊娠期高血压疾病通常在分娩12周内自发缓解,如持续存在,应诊断慢性高血压,特别是分娩6个月后仍有蛋白尿的患者,建议行肾活检明确是否患有慢性肾脏疾病。

Hypertensive disorders in pregnancy (HDP) is a common and serious clinical syndrome, characterized by hypertension, renal injury, and neurological symptoms in pregnancy, and is a major cause for maternal death. According to 2013 ACOG (American College of Obstetricians and Gynecologists) guideline, HDP is categorized as gestational hypertension, preeclamsia-eclamsia, chronic hypertension, and chronic hypertension complicated with preeclamsia. Patients with blood pressure of ≥160/110 mmHg need antihypertensive therapy of which the first-line drugs are calcium channel blockers and adrenoceptor blocking agents. Renin and angiotensin receptor blockers are contraindicated in the first trimester of pregnancy due to their potential teratogenicity. Patients with mild preeclampsia are suggested to receive expectant management, including antihypertensive medication, symptomatic treatment, and nutritional supportive treatment. HDP has a tendency to spontaneous remission within 12 weeks after delivery. Diagnosis of chronic hypertension is considered if hypertension persists. Renal biopsy should be advised to investigate the underlying chronic kidney disease if proteinuria persists more than six months after delivery.

表1 妊娠期高血压疾病诊断标准
表2 妊娠期高血压疾病患者降压药物的使用方法及不良反应
表3 妊娠期高血压疾病并发急性肾损伤的治疗方案
[1]
Ye C, Ruan Y, Zou L, et al. The 2011 survey on hypertensive disorders of pregnancy (HDP) in China: prevalence, risk factors, complications, pregnancy and perinatal outcomes [J]. PLoS One, 2014, 9(6): e100180.
[2]
Arulkumaran N, Lightstone L. Severe pre-eclampsia and hypertensive crises [J]. Best Pract Res Clin Obstet Gynaecol, 2013, 27(6): 877-884.
[3]
Schneider S, Freerksen N, Maul H, et al. Risk groups and maternal-neonatal complications of preeclampsia - Current results from the national German Perinatal Quality Registry [J]. J Perinat Med, 2011, 39 (3): 257-265.
[4]
Chaiworapongsa T, Chaemsaithong P, Yeo L, et al. Pre-eclampsia part 1: current understanding of its pathophysiology [J]. Nat Rev Nephrol, 2014, 10(8): 466-480.
[5]
American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Hypertension in pregnancy: report of the American College of Obstetricians and Gynecologists′ Task Force on Hypertension in Pregnancy [J]. Obstet Gynecol, 2013, 122(5): 1122-1131.
[6]
Livingston JC, Livingston LW, Ramsey R, et al. Magnesium sulfate in women with mild preeclampsia: a randomized controlled trial [J]. Obstet Gynecol, 2003, 101(2): 217-220.
[7]
Leeman M. Arterial hypertension in pregnancy [J]. Rev Med Brux, 2008, 29(4): 340-345.
[8]
Chaiworapongsa T, Chaemsaithong P, Steven J, et al. Pre-eclampsia part 2: prediction, prevention and management [J]. Nat Rev Nephrol, 2014, 10(9): 531-540.
[9]
Duley L, Henderson-Smart D J. Drugs for treatment of very high blood pressure during pregnancy [J]. Cochrane Database Syst Rev, 2002, 4: CD001449.
[10]
Rosenthal T, Oparil S. The effect of antihypertensive drugs on the fetus [J]. J Hum Hypertens, 2002, 16(5): 293-298.
[11]
Vikse BE, Irgens LM, Leivestad T, et al. Preeclampsia and the risk of end-stage renal disease [J]. N Engl J Med, 2008, 359(8): 800-809.
[12]
Wei Q, Zhang L, Liu X. Outcome of severe preeclampsia manifested as nephrotic syndrome [J]. Arch Gynecol Obstet, 2011, 283(2): 201-204.
[13]
Stratta P, Besso L, Canavese C, et al. Is pregnancy-related acute renal failure a disappearing clinical entity [J]? Renal failure, 1996, 18(4): 575-584.
[14]
Fakhouri F, Vercel C, Frémeaux-Bacchi V. Obstetric nephrology: AKI and thrombotic microangiopathies in pregnancy [J]. Clin J Am Soc Nephrol, 2012, 7(12): 2100-2106.
[15]
Nwoko R, Plecas D, Garovic V D. Acute kidney injury in the pregnant patient [J]. Clin Nephrol, 2012, 78(6): 478-486.
[16]
Prakash J, Niwas SS, Parekh A, et al. Acute kidney injury in late pregnancy in developing countries [J]. Renal failure, 2010, 32(3): 309-313.
[17]
刘力生.中国高血压防治指南2010[J]. 中华高血压杂志,2011, 19(8): 701-708.
[18]
Snydal S. Major changes in diagnosis and management of preeclampsia [J]. J Midwifery Womens Health, 2014, 59(6): 596-605.
[19]
van der Graaf AM, Toering TJ, Faas MM, et al. From preeclampsia to renal disease: a role of angiogenic factors and the renin-angiotensin aldosterone system [J]? Nephrol Dial Transplant, 2012, 27(Suppl 3): iii51-iii57.
[20]
Anderson UD, Olsson MG, Kristensen KH, et al. Review: Biochemical markers to predict preeclampsia [J]. Placenta, 2012, 33(Suppl): S42-S47.
[21]
Hofmeyr GJ, Belizán JM, von Dadelszen P, et al. Low-dose calcium supplementation for preventing preeclampsia: a systematic review and commentary [J]. BJOG, 2014, 121(8): 951-957.
[22]
Poprawski G, Wender-Ozegowska E, Zawiejska A, et al. Modern methods of early screening for preeclampsia and pregnancy-induced hypertension--a review [J]. Ginekol Pol, 2012, 83(9): 688-693.
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