How Should Blood Pressure Be Measured During Pregnancy?
How Should Blood Pressure Be Measured During Pregnancy?
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怀孕期间应该如何测量血压？
DOI：
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发表时间：
2005
期刊：
影响因子：
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通讯作者：
T. Pickering
中科院分区：
文献类型：
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作者：
T. Pickering
46高血压是美国产妇死亡的第二大原因（仅次于栓塞），也是死胎和新生儿死亡的主要原因。由于它在怀孕期间的治疗不比其他时候少，因此怀孕期间测量血压（BP）是产前护理最重要的方面之一也就不足为奇了。在正常妊娠中，收缩压和舒张压在妊娠中期下降约5-10 mm Hg，然后逐渐增加到足月时的起始水平。当然，高血压可能发生在怀孕之前，但更常见的是在怀孕期间发生，在这种情况下，它可能被归类为妊娠高血压或先兆子痫。在这两种情况下，血压水平变化非常快：血压的增加很少在20 - 20周之前开始，但可能是妊娠晚期（24-36周）的主要问题。美国国家高血压教育计划工作组发布的关于妊娠期间高血压管理的官方指南（最近一次修订于2000年7月1）对如何测量血压保持沉默。有一个简短的声明说，舒张压应该使用柯氏音的第五相位测量，也有一个建议，在怀孕前高血压的女性中，“诊断应该通过多次测量来确认，并可能包括家庭或其他办公室外的血压读数。没有关于测量BP的频率以及使用办公室外监测的声明。
VOL. VII NO. I JANUARY 2005 46 Hypertension is the second leading cause of maternal deaths in the United States (after embolism), and is also a major cause of stillbirths and neonatal mortality. Since it is no less treatable during pregnancy than at other times, it comes as no surprise that measurement of blood pressure (BP) during pregnancy is one of the most important aspects of prenatal care. In normal pregnancies, both systolic and diastolic pressure decrease about 5–10 mm Hg by the middle of pregnancy, and then gradually increase to the starting levels at term. Hypertension may, of course, precede pregnancy, but more commonly develops during it, in which case it may be classified as gestational hypertension or preeclampsia. In both cases, BP levels can change very quickly: the increase of BP rarely starts before ≈20 weeks, but may be a major problem by the third trimester (24–36 weeks). The official US guidelines on the management of high BP during pregnancy published by the working group of the National High Blood Pressure Education Program, which was most recently revised in July 2000,1 are surprisingly silent on how BP should be measured. There is a brief statement saying that diastolic pressure should be measured using the fifth phase of the Korotkoff sounds, and there is also a recommendation that in women who are hypertensive before pregnancy “the diagnosis should be confirmed by multiple measurements and may incorporate home or other out-of-office BP readings.” There is no statement concerning how frequently BP should be measured, nor on the use of out-ofoffice monitoring.