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AHA专访丨妊娠期得了高血压、糖尿病怎么办?
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 编辑:国际循环网 时间:2020/12/8 11:38:36 关键字:高血压 
  编者按:临床诊疗中,一部分女性可出现妊娠期高血压或糖尿病,对孕产妇和胎婴儿的危害非常大。妊娠期如何进行血糖和血压管理,怎样选择用药,如何进行干预?带着这一系列问题本刊特邀美国乔治亚州亚特兰大市埃默里大学医学院 Nanette K. Wenger教授进行了解答。
 
Nanette K. Wenger教授
美国乔治亚州亚特兰大市埃默里大学医学院
 
  《国际循环》:妊娠期间的高血压和糖尿病对女性来说是长期危害,您认为应怎样管理血糖和血压?
  Nanette K. Wenger教授:每个国家都有不同的治疗指南。当然,妊娠期间必须控制好糖尿病,但不可将血糖降得过低,尤其不希望女性降血糖,因为最重要的是要保持胎盘一定的灌注。血压也一样,如果血压很高,必须控制血压,但血压不可降至140/90 mm Hg以下,同样要保证胎盘的血流灌注。
 
  《国际循环》:妊娠期女性在用药选择方面有很多限制,在降压或降糖方面指南中有哪些用药推荐?
  Nanette K. Wenger教授:妊娠期间不可使用血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB),这是绝对禁忌药。针对妊娠女性,临床有许多安全的使用药物,例如钙通道阻滞剂、β受体阻滞剂、甲基多巴和肼屈嗪等。据我们所知,用于治疗糖尿病的药物没有问题,但对于较新的药物,目前所掌握的信息并不多。
 
  《国际循环》:妊娠期糖尿病对母亲的远期影响有哪些?
  Nanette K. Wenger教授:对于在妊娠期间患有高血压或糖尿病的女性,即使血压、血糖可能在妊娠末期消退,但可确定的是,其仍能增加女性的心血管疾病风险。因此,糖尿病或高血压复发的女性,必须非常仔细随访跟踪。同时,这部分女性还应采用标准的生活方式措施,即控制体重,心脏健康饮食,禁止吸烟,进行体育锻炼,但长期监测仍非常重要。
  英文访谈原文
  Every country has slightly different guidelines. Certainly we have to control diabetes during pregnancy, but we don’t want the blood sugar to get too low because we don’t want the woman to be hypoglycemic. The most important thing is to maintain placental perfusion. It is the same with blood pressure. If the blood pressure is very high, it must be controlled, but we don’t want it to get below 140/90 mm Hg, because we worry about placental perfusion.
  Certainly, you never use an angiotensin-converting enzyme inhibitor or an ARB during pregnancy. Those are absolutely contraindicated. There are a number of safe medications. The calcium channel blockers are safe. The beta blockers are safe. Alpha-methyldopa is safe. Hydralazine. The ones that would concern me most would be the ACEs and the ARBs because they are contraindicated. As far as we know, there is not a problem with the drugs used to manage diabetes, but for the newer drugs, we don’t have much information.
  I think the important thing is that for the woman who has hypertension during pregnancy or diabetes during pregnancy, even though they may subside at the end of the pregnancy, that identifies a woman of increased cardiovascular disease risk. She must be followed very carefully for the recurrent development of diabetes and for the return of hypertension. All of the standard lifestyle measures should be applied - weight control, heart healthy diet, no smoking, physical activity. But it is very important to do long term surveillance.
 

 

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