Essential hypertension in pregnancy

Essential hypertension is outlined in arterial blood pressure increased as the major clinical manifestations of vascular disease. Cause is not yet quite clear, but the incidence rate, age-related. My information "20 years of age, the incidence rate was 3.11%; 20 ~ 29 years 3.91%; 30 ~ 39 years 4.95%; After the 40-year-old has gone up significantly. Therefore, cowhide women of childbearing age, hypertension rare. Clinical manifestations of the pregnancy before 20 weeks repeated measurement of blood pressure in 18 .7/12kPa (140/90) above, or prior to the pregnancy diagnosed hypertension, known as essential hypertension in pregnancy. About 59% in patients with family history. Essential hypertension in pregnancy in the second trimester and blood pressure drop, or blood pressure below 21 .2/13.3kPa (160/100mmHg), fetal high survival rate; If the blood pressure greater than 21 .2/13.3kPa (160/100mmHg) fetal mortality rate has gone up significantly. People with essential hypertension pregnant women, about 10% ~ 20% in late pregnancy with pregnancy-induced hypertension. Blood pressure "24/14.6kPa (180/110), fetal mortality rate reached 23%; Also attached as pregnancy-induced hypertension, fetal mortality rate as high as 41.3%. Pregnancy-induced hypertension appeared sooner, fetal expected worse, in 32 gestational weeks ago with pregnancy-induced hypertension, 75% of intrauterine death. In addition, on the basis of essential hypertension in pregnancy hypertension, placental abruption the incidence of 2%. complicated than a simple pregnancy induced hypertension were higher. Diagnosis of normal blood pressure in different physiological conditions under certain fluctuations, anxiety, tension, stress or physical activity, blood pressure may rise. In addition, systolic blood pressure increase with the rise, and had normal blood pressure and hypertension boundary demarcation is not easy. 1979 China revised method of measuring blood pressure and hypertension diagnostic criteria are as follows : 1. After a 15-minute break. admission seating right arm blood pressure measurement, the measurement should be repeated several times until blood pressure is relatively stable. DBP to prevail voices disappear, such as the persistent voices disappear, it changes the sound when using numerical. The same one-hour intervals days, or every other day again verified. 2. Where systolic blood pressure ≥ 21.2kPa (160mmHg) and (or) DBP ≥ 12.6kPa (9 5mmHg), the diagnosis can be verified. BP 18.7 ~ ~ 12.6kPa 21.2/12 (140 ~ ~ 95mmHg 160/90 ) for the clinical hypertension. 3. Past history of hypertension, not for more than three months, the current inspection normal blood pressure were not included hypertension; As always this medication and check blood pressure normal, the diagnosis of hypertension should be. Women of childbearing age suffer from hypertension most of the first period, a rare vascular complications, and fundus, ECG, heart, Kidney function often no abnormality, it must only diagnosis based on arterial hypertension. The first visit in mid-pregnancy, due to peripheral expansion, hemodilution and placenta formation arteriovenous short circuit. will enable 40% of patients with systolic blood pressure decreased 2.7 kPa (20mmHg), which might complicate diagnosis. That is the first treatment of renal dysfunction, it is difficult to identify chronic glomerulonephritis or chronic pyelonephritis caused by the symptoms of hypertension, Essential hypertension or kidney disease caused. Treatment 1. Venous thrombosis treatment (1) General addressed : bed rest a ~ 2 weeks to ease leg pain, so tight sticky thrombosis in the vein of endometrial until aircraft and luminal patency. Chigaohuanshi, cardiopulmonary higher level, from the bed 20 ~ 30cm, knee buckling slightly for the benefit of venous return and reduce edema. Maintain patency stool, defecation so hard to prevent detachment of the thrombus. Wear long to get up after the reunification of elastic stockings 6 ~ 12 weeks, so superficial venous pressure, increase return and reduce lower extremity edema. (2) thrombolytic therapy : apply to three days after onset of pulmonary embolism or when. 1) streptokinase : half an hour before, intravenous hydrocortisone 25 ~ 50 mg or 5 ~ 10 mg dexamethasone, in order to prevent adverse reaction. Early dose of streptokinase 500,000 u plus 5% glucose saline fluid or 100 ml, within 30 minutes End intravenous drip, after 100,000 u / h maintained until the symptoms disappear, renewable drop 3 ~ 4 hours. Can also be used streptokinase 600,000 u hydrogenation of hydrocortisone 25 mg (or dexamethasone 25 mg) plus 5% glucose solution 25 0 ~ 500ml intravenously once every six hours. Generally used in conjunction with 3 ~ 5. 2) UK : adverse reaction, without application of adrenocortical hormones. Initial dose 3 ~ u 50,000 plus 5% glucose solution (or dextran -40) 250-500ml. in a two-hour intravenous infusion End, a daily two-three times. According to the daily maintenance dose determination of fibrinogen volume or euglobulin lysis time adjustments can be used in conjunction with a ~ 2 weeks. 3) fibrinolysin : 50000 ~ u 150,000 plus 5% glucose solution 250ml, within 30 minutes intravenous drip End. , 50000 u plus 5% glucose solution intravenously daily 2 ~ 3 times, on the 7th. 4) plasma concentrations (plasminogen) combined with streptokinase : Plasma original 90-mg or 120mg plus 150ml saline, intravenous infusion of 4 ~ 6 hours. Following the use of streptokinase 600,000 u 100 ml of normal saline solution intravenously 30 minutes trickling End, a daily meeting, and continued on the 5th. (3) dextran or dextran -70 -40 500-1000ml, intravenously once daily, used in conjunction with 10 ~ 14, a dredge vessel. (4) Surgical treatment : thrombosis or more conservative treatment fails, it may consider the purposes of deep vein thrombosis extraction, leg vein ligation. 2. Treatment of pulmonary embolism : pulmonary embolism, was advised to take the following measures. (1) oxygen : to improve arterial oxygen tension. (2) pain : chest pain, available 30 ~ 60 mg of papaverine hydrochloride or pethidine (meperidine) 50 ~ 100 mg intramuscular injection. or 5 ~ 10 mg of morphine, subcutaneous injection. (3) Flank : atropine 0.5 ~ 1 mg intravenous, each a four-hour time, suggesting sluggish nerve resistance, prevent or improve the pulmonary artery and coronary reflex spasm. Aminophylline 0.25 ~ 0.5g plus 5% glucose solution 100-250ml, intravenous drip, to remove bronchial spasm. (4) Anti-shock : 20-40mg of dopamine, Aramine or 20 ~ 40mg plus 5% glucose solution 200ml, intravenous drip. (5) Strong Heart : Deacetylation LANATOSIDE (West to Portland), or 0.4 ~ folic drug LANATOSIDE K0.25mg plus 50% glucose solution , intravenous injection.