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ENGLISH ABSTRACT
妊娠期高血压疾病诊治指南（2020）
中华医学会妇产科学分会妊娠期高血压疾病学组
作者及单位信息
·
DOI： 10.3760/cma.j.cn112141-20200114-00039
Diagnosis and treatment of hypertension and pre-eclampsia in pregnancy: a clinical practice guideline in China（2020）
Hypertensive Disorders in Pregnancy Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association
Authors Info & Affiliations
Hypertensive Disorders in Pregnancy Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association
·
DOI： 10.3760/cma.j.cn112141-20200114-00039
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摘要

妊娠期高血压疾病是全世界孕产妇和围产儿死亡的主要原因之一。中华医学会妇产科学分会妊娠期高血压疾病学组在2015版指南的基础上进行修订，并颁发妊娠期高血压及子痫前期临床诊治指南2020版。在2020版指南中，明确强调了妊娠期高血压疾病孕妇发病的背景复杂，尤其子痫前期-子痫存在多因素-多机制-多通路致病的综合征发病性质。不仅孕妇高血压的临床表现程度和表现形式复杂，子痫前期的首发症状也存在多样性。于此基础上，本指南在强调各种风险因素识别同时，提出应重视妊娠期的临床预警信息，强化产前检查，提高早期识别和早期诊断能力，并在降压和预防抽搐等对症处理的基础上，注意各种诱发病因的诊治。本指南旨在为妊娠期高血压及子痫前期的临床诊治提供指导，并扩展临床多方面诊治思路。

引用本文

中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南（2020）[J]. 中华妇产科杂志,2020,55(04)：227-238.

DOI:10.3760/cma.j.cn112141-20200114-00039

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中华医学会妇产科学分会妊娠期高血压疾病学组在《妊娠期高血压疾病诊治指南（2015）》 [ 1 ]的基础上，更新发布"妊娠期高血压疾病诊治指南（2020）"版本。本指南根据对妊娠期高血压疾病的新的认识，参考了美国、加拿大、英国、澳大利亚、国际妇产科联盟（FIGO）、WHO等最新的相关指南 [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ]，并结合我国国情、临床研究及实践经验，遵循循证医学理念，对有关的治疗方案给出了证据评价 [ 11 ]。本指南更加强调对妊娠期高血压疾病的临床预警和早期识别能力，强调早预警、早发现和早干预，进一步规范和指导我国妊娠期高血压疾病的临床处理。
本指南的循证证据等级及推荐建议：（1）证据等级：①Ⅰ：证据来自至少1个高质量的随机对照试验；②Ⅱ-1：证据来自设计良好的非随机对照试验；③Ⅱ-2：证据来自设计良好的队列（前瞻性或回顾性）研究或者病例对照研究；④Ⅱ-3：证据来自不同时间或地点干预措施效果的差异研究；⑤Ⅲ：基于临床经验、描述性研究或者专家委员会报告等的专家意见。（2）推荐建议：①A：证据适合推荐应用于临床预防；②B：证据较适合推荐应用于临床预防；③C：现有的证据间不一致；④D：有一定的证据不推荐用于临床预防；⑤E：有相当证据不推荐用于临床预防；⑥L：没有足够的证据（数量或质量）可以提出建议，但是，其他因素可能会影响决策。
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附录
2020年4期继续教育题目（一）（单项选择题）：

1．妊娠相关高血压疾病概括为4类，包括妊娠期高血压（gestational hypertension）、子痫前期-子痫（pre-eclampsiaeclampsia）、妊娠合并慢性高血压（chronic hypertension）、慢性高血压伴发子痫前期（chronic hypertension with superimposed preeclampsia）。慢性高血压为孕妇存在的各种原因的继发性或原发性高血压，可以有不同的表现形式：（　）

A.白大衣高血压

B.隐匿性高血压

C.短暂性高血压

D.产前检查时发现一过性高血压

E.以上表现都有可能

2．在产前检查时，孕妇的尿常规显示尿蛋白（+），不可能的原因是：（　）

A.存在自身免疫性疾病

B.存在尿液污染可能

C.尿比重<1.030时

D.肾脏疾病

3．子痫前期首发的临床症状不可能表现为：（　）

A.高血压伴有蛋白尿

B.单纯蛋白尿表现

C.单纯血压升高

D.胎儿生长正常

4．子痫发作前可能有哪些前驱症状：（　）

A.持续性枕部头痛

B.持续性前额头痛

C.视物模糊、畏光

D.神经反射亢进

E.以上都有可能是子痫发作的前驱症状

5．重度子痫前期的临床表现不包括：（　）

A.持续性头痛、视觉障碍

B.低蛋白血症伴腹水、胸水或心包积液

C.胎儿生长正常

D.微血管内溶血表现伴有贫血

（继续教育的答题方式及获得学分的方法见插页。答案见下期）

（2020年1期继续教育题目的答案：1.C 2.D 3.B 4.A 5.B）

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备注信息
A
杨孜，北京大学第三医院妇产科　100191，Email： mocdef.6ab215002gnay_iz；
B
张为远，首都医科大学附属北京妇产医院产科　100026，Email： mocdef.labiamtoh1299ywgnahz
C
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字号
小中大