从指南变迁看妊娠期高血压疾病的诊治
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摘要
妊娠期高血压疾病(hypertensive disorders in pregnancy,HDP)是妊娠与血压升高并存的一组疾病。加强孕期的监测和孕期血压的管理是预防子痫前期、改善母婴结局的关键。血压和蛋白尿是孕期监测的重点。指南推荐可用于孕期的降压药物包括甲基多巴、拉贝洛尔或硝苯地平等。子痫前期的早期筛查和干预是女性孕期心血管风险防范的关键之一。除药物干预之外,体重控制、生活方式干预、筛查和治疗阻塞性睡眠呼吸暂停等也不容忽视。
Hypertensive disorders in pregnancy(HDP)is a group of diseases including high blood pressure during pregnancy. Strengthening clinical monitoring, risk factors assessment and early intervention would promote outcomes of women and their children. Blood pressure and proteinuria are key monitoring during pregnancy. Antihypertensive drugs recommended for pregnancy include methyldopa, labellol, or nifedipine. Early screening and intervention of preeclampsia is one of the keys to the prevention of cardiovascular risk during pregnancy. In addition to medication, weight control, screening and treatment of obstructive sleep apnea(OSA), lifestyle intervention and so on can not be ignored.
Hypertensive disorders in pregnancy(HDP)is a group of diseases including high blood pressure during pregnancy. Strengthening clinical monitoring, risk factors assessment and early intervention would promote outcomes of women and their children. Blood pressure and proteinuria are key monitoring during pregnancy. Antihypertensive drugs recommended for pregnancy include methyldopa, labellol, or nifedipine. Early screening and intervention of preeclampsia is one of the keys to the prevention of cardiovascular risk during pregnancy. In addition to medication, weight control, screening and treatment of obstructive sleep apnea(OSA), lifestyle intervention and so on can not be ignored.
引文
[1]Pauli JM,Repke JT.Pitfalls With the New American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy[J].Clin Obstet Gynecol,2017,60(1):141-152.
[2]Carey RM,W helton PK.Prevention,Detection,Evaluation,and Management of High Blood Pressure in Adults:Synopsis of the2017 American College of Cardiology/American Heart Association Hypertension Guideline[J].Ann Intern Med,2018,168(5):351-358.
[3]Tranquilli AL,Dekker G,Magee L,et al.The classification,diagnosis and management of the hypertensive disorders of pregnancy:A revised statement from the ISSHP[J].Pregnancy Hypertens,2014,4(2):97-104.
[4]Brown MA,Magee LA,Kenny LC,et al.The hypertensive disorders of pregnancy,ISSHP classification,diagnosis&management recommendations for international practice[J].Hypertension,2018,72(1):24-43.
[5]Brown MA.Is there a role for ambulatory blood pressure monitoring in pregnancy[J].Clin Exp Pharmacol Physiol,2014,41(1):16-21.
[6]Lee-Ann Hawkins T,Brown MA,Mangos GJ,et al.Transient gestational hypertension:Not always a benign event[J].Pregnancy Hypertens,2012,2(1):22-27.
[7]杨孜,张为远.妊娠期高血压疾病诊治指南(2015)[J].中华产科急救电子杂志,2015,4(4):206-213.
[8]Magee LA,von Dadelszen P,Rey E,et al.Less-tight versus tight control of hypertension in pregnancy[J].N Engl J Med,2015,372(5):407-417.
[9]李玉明,杨宁.重视妊娠高血压子痫前期的早期筛查[J].中华心血管病杂志,2016,44(3):193-196.
[10]Rolnik DL,Wright D,Poon LC,et al.Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia[J].N Engl J Med,2017,377(7):613-622.
[11]Louis JM,Mogos MF,Salemi JL,et al.Obstructive sleep apnea and severe maternal-infant morbidity/mortality in the United States,1998-2009[J].Sleep,2014,37(5):843-849.
[12]Rice J R,Larrabure-Torrealva G T,Fernandez M A L,et al.High risk for obstructive sleep apnea and other sleep disorders among overweight and obese pregnant women[J].BMC Pregnancy and Childbirth,2015,15(1):198.
[2]Carey RM,W helton PK.Prevention,Detection,Evaluation,and Management of High Blood Pressure in Adults:Synopsis of the2017 American College of Cardiology/American Heart Association Hypertension Guideline[J].Ann Intern Med,2018,168(5):351-358.
[3]Tranquilli AL,Dekker G,Magee L,et al.The classification,diagnosis and management of the hypertensive disorders of pregnancy:A revised statement from the ISSHP[J].Pregnancy Hypertens,2014,4(2):97-104.
[4]Brown MA,Magee LA,Kenny LC,et al.The hypertensive disorders of pregnancy,ISSHP classification,diagnosis&management recommendations for international practice[J].Hypertension,2018,72(1):24-43.
[5]Brown MA.Is there a role for ambulatory blood pressure monitoring in pregnancy[J].Clin Exp Pharmacol Physiol,2014,41(1):16-21.
[6]Lee-Ann Hawkins T,Brown MA,Mangos GJ,et al.Transient gestational hypertension:Not always a benign event[J].Pregnancy Hypertens,2012,2(1):22-27.
[7]杨孜,张为远.妊娠期高血压疾病诊治指南(2015)[J].中华产科急救电子杂志,2015,4(4):206-213.
[8]Magee LA,von Dadelszen P,Rey E,et al.Less-tight versus tight control of hypertension in pregnancy[J].N Engl J Med,2015,372(5):407-417.
[9]李玉明,杨宁.重视妊娠高血压子痫前期的早期筛查[J].中华心血管病杂志,2016,44(3):193-196.
[10]Rolnik DL,Wright D,Poon LC,et al.Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia[J].N Engl J Med,2017,377(7):613-622.
[11]Louis JM,Mogos MF,Salemi JL,et al.Obstructive sleep apnea and severe maternal-infant morbidity/mortality in the United States,1998-2009[J].Sleep,2014,37(5):843-849.
[12]Rice J R,Larrabure-Torrealva G T,Fernandez M A L,et al.High risk for obstructive sleep apnea and other sleep disorders among overweight and obese pregnant women[J].BMC Pregnancy and Childbirth,2015,15(1):198.