STUDY ON THE PATHOPHYSIOLOGY OF PREECLAMPSIA : THE MECHANISM OF VASOSPASMS

先兆子痫具有妊娠特有的病理生理学障碍，其特征在于血管收缩和高凝状态。我们研究了许多先兆子痫病例的磁共振血管造影，发现脑动脉痉挛。我们从血管痉挛的角度提出子痫前期是妊娠期血管痉挛综合征，通过对凝血/纤溶研究结果的分析，提出以下假设：1）即使在重度子痫前期患者中，高凝状态较低的情况下，阴道分娩也可以成功; 2）重度子痫前期患者的过度高凝状态与终止妊娠有关，特别是由母体因素加重引起的，以及3）在这些标志物中，血小板计数减少（DELTA pit）以及妊娠期间D-二聚体和AT-Ⅲ的增加被认为是终止妊娠并发严重先兆子痫的有用的床边预测标记。我们揭示了布比卡因长期硬膜外麻醉在重度子痫前期患者中的有效性。这些事实表明，先兆子痫的原因涉及交感神经的慢性刺激。

Preeclampsia has pathophysiological disorders specific to pregnancy characterized by vasoconstriction and hypercoagulability. We investigated MR angiography in many cases of preeclampsia and revealed vasospasms of cerebral arteries. We proposed that preeclampsia was the angiospastic syndrome of pregnancy from the view point of vasospasms.An analysis of the results of coagulation/fibrinolysis investigation lead to the hypothesis that 1) even in patients with severe preeclampsia, vaginal deliveries can be successful in cases with a lower hypercoagulable state, 2) an excessive hypercoagulable state in patients with severe preeclampsia is associated with the termination of pregnancy, especially resulting from the aggravation of maternal factors, and 3) among these markers, a depletion in platelet counts (DELTA pit) and an increase in the D-dimer and AT-Ill during pregnancy are thought to be useful bedside predictive markers for the termination of pregnancy complicated by severe preeclampsia.Chronic local cold stimulation of the soles of the paws induces preeclampsia-like phenomena in pregnant and nonpregnant rats, and we revealed the effectiveness of long-term epidural anesthesia by bupivacaine in patients with severe preeclampsia. These facts suggest that the cause of preeclampsia is involved in chronic stimulation of the sympathetic nerve.