• 简介　　　　• 一览表　　　　• 症状　　　　• 治疗
• 饮食习惯的改变　　　• 生活方式的改变　　　• 营养补充剂
• 整体疗法　　　• 参考文献

　　“产前惊厥”指的是在怀孕第20周后出现的高血压、水肿和蛋白尿的联合症状[1]，在严重程度上，产前惊厥可以从轻微到严重；轻微的形式有时被叫做伴有蛋白尿的、怀孕导致的高血压[2]或者是伴有蛋白尿的妊娠高血压[3]。

　　即使只是患有很轻微的产前惊厥，这样的女性也应该被卫生保健专业人士严密地监控。要保证对其密切的观察，住院是很有必要的[4]。

　　尽管一些因素被提出对产前惊厥的发生产生作用，但其发生的原因仍不明确[5，6]。

　　产前惊厥在初次怀孕的妇女中更常见[7]，同样容易出现于肥胖[8，9]、糖尿病[10]或有妊娠高血压的妇女中[11，12，13]。在以往妊娠中曾出现过产前惊厥的妇女发生可能性也会增高[14]。产前惊厥也和钙质缺乏[15]、抗氧化剂缺乏[16，17，18]、母亲年龄偏大[19]及工作压力[20，21，22]有关。

产前惊厥的辅助疗法

产前惊厥的症状

　　典型的症状出现在怀孕20周之后，包括出现面部和手的水肿、视觉障碍、头痛和高血压。在严重的产前惊厥患者中，症状更加明显。黄疸也可能出现。严重的产前惊厥可能导致惊厥，如果没有及时治疗甚至可以导致母亲和胎儿的死亡[23]。同惊厥一样，严重的产前惊厥是需要住院的临床急症[24，25]。

医药治疗

　　处方药被用来降低高血压。处方药中众所周知的利尿剂类被普遍用来治疗高血压。经常被使用的药包括噻嗪类利尿剂，比如：氢氯噻嗪（hydrochlorothiazide，HydroDIURIL®)，吲哒帕胺indapamide (Lozol®)，美托拉宗metolazone (Zaroxolyn®)；袢利尿剂，比如速尿furosemide (Lasix®), 布美它尼bumetanide (Bumex®)和托拉塞米torsemide (Demadex®); 以及保钾利尿剂, 比如安体舒通spironolactone (Aldactone®), 氨苯喋啶triamterene (Dyazide®, Maxzide®), 和阿米洛利amiloride (Midamor®). 利尿剂通常和β-受体阻断剂联合使用。比如普萘洛尔propranolol (Inderal®), 美托洛尔metoprolol (Lopressor®, Toprol XL®), 阿替洛尔atenolol (Tenormin®)和比索洛尔bisoprolol (Zebeta), 或者是使用血管紧张素酶抑制剂，比如卡托普利captopril (Capoten®), 贝那普利benazepril (Lotensin®), 赖诺普利lisinopril (Zestril®, Prinivil®), 依那普利enalapril (Vasotec®)和奎那普利quinapril (Accupril®). 还可使用血管紧张素II受体拮抗剂, 比如氯沙坦losartan (Cozaar®), 颉沙坦valsartan (Diovan®), 厄贝沙坦irbesartan (Avapro®), 坎地沙坦candesartan (Atacand®)和替米沙坦telmisartan (Micardis®), 这些药物都被普遍应用，或者单独使用，或者和其他药剂联合使用。再有钙通道拮抗剂，比如氨氯地平amlodipine (Norvasc®), 维拉帕米verapamil (Calan SR®, Verelan PM®)和地尔硫卓diltiazem (Cardizem CD®), 也可被单独或和其他药物联合使用来治疗高血压。另一类被普遍使用的抗高血压药是交感神经阻滞剂，包括哌唑嗪prazosin (Minipress®), 多沙唑嗪doxazosin (Cardura®), 特拉唑嗪terazosin (Hytrin®)和甲基多巴methyldopa (Aldomet®)。

　　其他针对产前惊厥的治疗包括严格的卧床休息，保持正常的盐的摄入，静脉滴注硫酸镁，尽可能住院留观。产前惊厥的权威性的常规治疗是引产或剖腹生产。

可能有益的饮食习惯

　　在其他引起高血压的情况中，盐的限制和利尿剂的使用会对病情有益。而在产前惊厥引起高血压时，限制用盐和使用利尿剂会减少肾和胎盘的血流，因此可能会加重产前惊厥[26]。在产前惊厥情况下，需要通过不限制摄盐和增加摄水来维持正常的血容量和胎盘的循环血量[27]。

　　有研究数据显示：高含量的反式脂肪酸饮食和产前惊厥高风险相关[28]。反式脂肪酸在部分氢化的植物油中存在，比如人造黄油。油炸过的食物（比如：法式炸薯条）也富含反式脂肪酸。

可能有益的生活方式

　　在胎儿出生之前，对母亲规范的照料对于防治和早期发现产前惊厥是最关键的。

　　工作压力（缺乏对工作节奏、时间和休息频率的控制）会是有害的，并且减少工作压力在防止产前惊厥方面会是有益的[29]。在研究中发现，暴露于高工作压力的女性比低工作压力的女性有更高的危险性发生产前惊厥，或者在更低的程度上，发生妊娠高血压危险性更高。在这项研究中，工作压力的评估是基于评估在职心理需求和做出决定的自由程度的得分。高压力被定义为高的心理需求和低的决定自由度，而低压力被定义为低需求、高自由度[30]。

　　对于有产前惊厥的女性来说，产科医生和助产士经常推荐卧床休息并采取左侧卧位；这样的姿势能增加尿的排出，从而有助于减少水肿和降低血压[31]。然而，一项临床试验综述推断：卧床休息会明显加重怀孕导致的高血压[32]。患有产前惊厥的妇女应该和她们的医生讨论一下卧床休息的利弊。

可能有益的营养补充剂

钙

　　缺乏钙质已被认为和产前惊厥相关[33]。在无数的对照试验中，口服钙质补充剂已经被研究证实是可能的预防措施[34，35，36，37]。在大多数试验中，补充钙质使产前惊厥发生率明显下降[38，39，40，41，42，43]，但仍有一些试验结果报告没有明显改变[44]。一项双盲试验[45]的分析发现：钙质补充在预防产前惊厥方面是高度有效的。然而另一项大型并且计划完善的双盲试验[46]和一个基于六个双盲试验[48，49，50，51，52，53]的严格分析[47]却得出结论：钙质补充并没有减低低发生率的健康妇女中产前惊厥危险性，然而，对于高发生率的健康妇女（比如：缺乏钙质的人群），数据却清晰且明显地显示了钙质补充在减低产前惊厥危险性上的有益效果[54，55，56]。

　　国家健康协会推荐正常孕期妇女每天摄入1200至1500毫克钙质[57]。而对于有产前惊厥危险性的女性，大多数试验显示每天2000毫克的钙质补充能减少发生率[58]。虽然如此，许多医生仍然建议每天不超过1500毫克的补充量。

高半胱氨酸

　　患有产前惊厥的妇女，其血液中高半胱氨酸水平大多有所升高[59，60，61，62]。研究显示升高的高半胱氨酸水平出现在产前惊厥发生之前[63]。升高的高半胱氨酸损害血管的内层[64，65，66，67，68，69，70]，因此会导致产前惊厥症状产生——高血压、水肿和蛋白尿[71]。

　　在一项研究中，对于以前怀孕时曾出现过产前惊厥和高的高半胱氨酸水平的妇女，每天给予5毫克叶酸和250毫克维生素B6，这成功地降低了其血中高半胱氨酸水平[72]。在另一项研究维生素B6对产前惊厥发生率影响的试验中，采取每天两次补充5毫克维生素B6，这也有效地降低了产前惊厥的发生率[73]。在这个试验中，受试妇女的高半胱氨酸水平没有被评估。事实上，还没有试验能确定是否降低的高半胱氨酸水平降低了产前惊厥的发生率或严重程度。尽管还缺乏证据证明升高的高半胱氨酸水平引起产前惊厥，仍有许多医生认为，出现高的高半胱氨酸水平的怀孕妇女应设法将其水平降低至正常。

锌

　　锌的临界性缺乏在很多患有产前惊厥的妇女中都有报道[74，75]。给怀孕妇女开出补充铁和叶酸的处方是普遍的做法，这会导致锌的吸收减少[76]。而研究锌的补充和产前惊厥关系的试验却得出了矛盾的结果。在一项双盲试验中，一组妇女得到多重矿物质补充，包括每天20毫克锌，另一组妇女补充相同营养，唯一不同的是缺少锌，前者产前惊厥发生率比后者明显下降[77]。然而，在另一项双盲试验中，每天补充20mg锌的妇女的产前惊厥发生率却高于得到安慰剂的对照组[78]。还有一项试验中，锌没能防止产前惊厥的发生[79]。因此，现在的证据还不能足够支持这一结论：锌的使用是防止产前惊厥的方法。

鱼油

　　鱼油的补充已被建议用于降低产前惊厥的发生率[80，81]。然而，对照试验显示，这没有减轻症状[82]或是防止产前惊厥[83，84]。

抗氧化剂

　　患有产前惊厥的妇女被发现缺乏抗氧化剂[85，86]。在一些[87，88]，但不是所有的研究中[89]，曾经报道过，产前惊厥患者缺乏维生素C、维生素E和β-胡萝卜素。在一项双盲试验中，补充维生素C（每天1克）和维生素E（每天400国际单位）使高危妇女产前惊厥发生率降低了76%[90]。然而，对于那些已经遭遇这样病情的患者来说，补充相同的维生素效果很不明显[91]。

镁

　　镁的缺乏也被认为是引起产前惊厥的可能原因[92，93，94，95，96]。在一项试验中，补充镁能降低高危妇女产前惊厥的发生率[97]。但在另一项双盲试验中却没有同样效果[98]。

维生素B2

　　缺乏维生素B2的妇女比维生素B2水平正常的妇女更有可能发生产前惊厥[99]。在一个发展中国家观察到了这样的结果，在那里，维生素B2缺乏比美国更普遍。维生素B2不足可能导致了疾病发展最根本的异常。

有无副作用及药物之间相互作用？

请参考各种补充剂的副作用及相互作用。

参考文献
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