Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK.
Curr Opin Anaesthesiol. 2020 Jun;33(3):305-310. doi: 10.1097/ACO.0000000000000835.
Preeclampsia remains an important cause of maternal and neonatal morbidity and mortality. Recent interest in angiogenic biomarkers as a prognostic indicator is reviewed, together with analgesic, anaesthetic and critical-care management of the preeclamptic patient.
There has been recent interest in the angiogenic biomarkers placental growth factor and soluble fms-like tyrosine kinase-1 in establishing the diagnosis of preeclampsia and guiding its management. Neuraxial blocks are recommended for both labour and operative delivery if not contraindicated by thrombocytopenia or coagulopathy, although a safe lower limit for platelet numbers has not been established. For spinal hypotension phenylephrine is noninferior to ephedrine in preeclamptic parturients and may offer some benefits. When general anaesthesia is required, efforts must be made to blunt the hypertensive response to laryngoscopy and intubation. Transthoracic echocardiography has emerged as useful technique to monitor maternal haemodynamics in preeclampsia.
Improvements in the diagnosis of preeclampsia may lead to better outcomes for mothers and babies. Peripartum care requires a multidisciplinary team approach with many preeclamptic women receiving neuraxial analgesia or anaesthesia. Women with severe preeclampsia may require critical-care support and this should meet the same standards afforded to other acutely unwell patients.
子痫前期仍然是孕产妇和新生儿发病率和死亡率的重要原因。本文复习了血管生成生物标志物作为预测指标的最新研究进展，以及子痫前期患者的镇痛、麻醉和重症监护管理。
近年来，人们对胎盘生长因子和可溶性 fms 样酪氨酸激酶-1 等血管生成生物标志物在诊断子痫前期和指导其治疗方面的作用产生了浓厚兴趣。如果没有血小板减少症或凝血功能障碍的禁忌证，椎管内阻滞推荐用于分娩和手术分娩，尽管尚未确定血小板数量的安全下限。对于脊髓低血压，去氧肾上腺素在子痫前期产妇中与麻黄碱相比非劣效，并且可能具有一定的优势。当需要全身麻醉时，必须努力减轻喉镜检查和插管引起的高血压反应。经胸超声心动图已成为监测子痫前期产妇血液动力学的有用技术。
子痫前期诊断方法的改进可能会改善母婴结局。围产期护理需要多学科团队的方法，许多子痫前期妇女接受了椎管内镇痛或麻醉。严重子痫前期的妇女可能需要重症监护支持，这应符合为其他急性不适患者提供的相同标准。
