Treatment of hypertension in pregnancy

  Because the cause of hyperemesis is still unknown, so far according to its prevalent factors and pathophysiological changes in the characteristics of antispasmodic, hypotensive, diuretic and timely termination of pregnancy and other principles of treatment.  I. Application of antispasmodic drug magnesium sulfate magnesium sulfate is still the drug of choice for the treatment of hyperemesis. Pre-eclampsia or eclampsia patients magnesium sulfate application, the first dose of 25% magnesium sulfate 10ml plus 50% glucose solution 20ml intravenous slow injection, or magnesium sulfate 5g added to 50% glucose solution 100-200ml intravenous drip in 1 hour, later magnesium sulfate 60ml plus dextrose or glucose solution 1000ml, to 1.5 to 2g per hour rate of intravenous drip If the first dose is 10~5g/h, the serum magnesium solubility will rise immediately, reach the peak after 1 hour, and start to fall after 2 hours. If the first dose of 10 ~ 14g (including intravenous drip and intramuscular injection), the total amount of 24 hours to 30 ~ 35g, the highest concentration of serum magnesium up to 2.5 ~ 3mmol / L, clinically visible effect.  Second, the application of antihypertensive drugs 1, the principle of medication: ① to not affect the cardiac output, renal blood flow and placental perfusion as the principle; ② where diastolic blood pressure ≥ 14.7kPa (110mmHg) when to be intravenous drip.  2.Hydrazinepyridazine: It can block the α-receptor and make the peripheral blood vessels dilate and blood pressure drop. The dose is 12.5~25mg added to 250~500ml of glucose solution, intravenous drip, generally 20~30 drops per minute, blood pressure is maintained at 18.6~12.0kPa (140/90mmHg) that need to slow down the drip rate to maintain it.  3.Lorazepam: It has the effect of promoting fetal maturation, reducing platelet consumption and increasing the level of prostacyclin. When intravenous drip, blood pressure can gradually drop, but no palpitations, flushing, vomiting and other adverse reactions, more than hydrazinepyridazine is more acceptable to patients. Dose: 50mg or 100mg plus 5% glucose solution 500ml intravenous drip, 20-40 drops per minute, adjust the drip rate according to blood pressure, 5 days as a course of treatment. After the blood pressure is stabilized, it can be changed to 100mg orally, 3 times a day.  4.Nifedipine: 10mg under the tongue, 3 times a day or every 6 hours, the total amount of 24 hours does not exceed 60mg; 7 days is a course of treatment, available for 3-5 courses of treatment, between courses, no intermittent.  5.Meproline: Its mechanism of action is that the ACE inhibitory factor prevents the conversion of angiotensin Ⅰ (AT-Ⅰ) into angiotensin Ⅱ (AT-Ⅱ), thus achieving the effect of lowering blood pressure and inhibiting the effect of aldosterone. The dose is 12.5~25mg, taken orally twice daily, with good antihypertensive effect.  6.Nitroprusside: A few patients with severe hyperemesis have very high blood pressure, which cannot be controlled by the above-mentioned drug treatment, this drug can be used under close observation.  7.Prazosin: The first dose is 0.5mg, later it can be changed to 0.5~1mg, taken orally 3 times a day, and the dose can be increased gradually.  Third, the application of sedatives 1, diazepam (Valium): for eclampsia or clinical manifestations of pre-eclampsia patients who are about to convulsions, 10-20mg of diazepam can be added to 25% glucose solution 20-40ml, slowly intravenous push, 5-10 minutes after injection, can quickly control convulsions. If magnesium sulfate has been used intravenously, then diazepam 10mg intravenous injection is appropriate. For patients with moderate hyperemesis, also give diazepam 2.5mg, 3 times a day orally.  2, sodium amytal: for the convulsions have occurred, by the magnesium sulfate failed to control, can be used sodium amytal 0.2 ~ 0.5g plus 50% glucose solution 20ml intravenous injection, 5 ~ 10 minutes after injection. It is not appropriate to use sodium amytal intravenously for several times, so as to avoid the synergistic effect with magnesium sulfate and respiratory depression. Oral dose of 0.1g, once every 8 hours, the clinical use is generally only 1 to 2 days.  3, morphine: 4, diuretic and dehydrating agent application of hypertension, although often accompanied by edema, but in recent years that diuretics can not be used routinely.  (1) furosemide (tachyphylaxis): commonly used furosemide 20-40mg plus 5% glucose solution 20-40ml, intravenous injection, and can be repeated according to the condition, can have a good effect.  (2) Mannitol In conclusion, the common drugs used in the treatment of hyperemesis are mainly antispasmodic and antihypertensive, while volume expansion and diuretic need to be applied according to the condition and laboratory index.