MATERNAL BRAIN BLOOD FLOW IN NORMAL PREGNANCY AND PREECLAMPSIS

怀孕与生理血管扩张有关。我们已经定义了， 利用多普勒超声对脑动脉进行部分生理学检查 正常妊娠期间血流速度和阻力的变化。 子痫前期是一种普遍存在的内皮疾病，会导致血管痉挛和 动脉阻力增加。血管反应性增强 比临床症状(高血压/蛋白尿)早几周或 月份。在此基础上，已经对一些测试进行了研究，以确定其 有能力预测先兆子痫，但目前还没有临床应用 很有用。 我们已经确定了大脑/眼眶多普勒的明显差异 子痫前期孕妇与正常血压孕妇之间的参数。 此外，我们还开发了三个多普勒分析模型，这些模型可以 用于可靠地区分正常血压和正常血压 子痫前期妇女脑动脉阻力指数和 估计的脑灌注压。这些模型可以调整以适应 其他血管床，包括肾脏、子宫胎盘和外周 动脉循环。我们在这项提案中的目标是表明 多支血管小动脉的同时多普勒研究 病床可以(I)识别先兆子痫的临床前和亚临床状态 阶段，以及(Ii)已确诊的早产儿先兆子痫患者组 变成那些会失败或对保守派拖延时间做出回应的人 管理层。我们将在大脑中使用标准的多普勒方法， 眼眶、肾脏、子宫胎盘和外周动脉床 确定派生阻力、流速和血流灌注指数。在……里面 此外，还将使用血管反应性的动态测试 区分应力分布。计划了两个纵向协议： 答：一项对320名低风险初孕妇女的门诊研究 每月从16周或更短的时间到足月/分娩，然后在6、12和 产后24周；B：30例早产先兆子痫患者的内部方案 实行临时性管理，按日考核 最初，每隔一天稳定一次，直到分娩。早些时候 动脉功能异常的检测可允许识别 临床体征出现前先兆子痫。在已建立的 先兆子痫，血管痉挛恶化的证据将提供信息 论病程及治法的有效性 受雇的。

Pregnancy is associated with physiologic vasodilation. We have defined, using Doppler ultrasound in cerebral arteries, some of the physiologic changes in blood velocity and resistance during normal pregnancy. Preeclampsia, an ubiquitous endothelial disease, causes vasospasm and an increase in arterial resistance. Increased vascular reactivity predates the clinical syndrome (hypertension/proteinuria) by weeks or months. Based on this, a number of tests have been studied for their ability to predict preeclampsia, but currently none that are clinically useful. We have identified distinct differences in cerebral/orbital Doppler parameters between preeclamptic and normotensive pregnant women. Furthermore, we have developed 3 Doppler analytical models which can be used to reliably differentiate between term normotensive and preeclamptic women using cerebral arterial resistance indices and estimated cerebral perfusion pressure. These models can be adapted to other vascular beds including the renal, uteroplacental and peripheral arterial circulations. Our objectives in this proposal are to show that simultaneous Doppler studies of small arteries in a number of vascular beds can (i) identify preeclampsia in its preclinical and subclinical phases, and (ii) group patients with established preterm preeclampsia into those who will fail or respond to conservative temporizing management. We will use standard Doppler methods in the cerebral, orbital, renal, uteroplacental and peripheral arterial beds to determine derived resistance, flow-velocity, and perfusion indices. In addition dynamic tests of vascular reactivity will be used to differentiate stress profiles. Two longitudinal protocols are planned: A: an outpatient study of 320 low-risk, primigravid women, evaluated monthly from 16 weeks or less until term/delivery, and then at 6, 12 and 24 weeks postpartum; B: an in-house protocol of 30 preterm preeclamptics undergoing temporizing management, evaluated on a daily basis initially, and once stable every other day, until delivery. Early detection of abnormal arterial function may allow identification of preeclampsia before emergence of clinical signs. In established preeclampsia, evidence of worsening vasospasm will provide information on the course of the disease and the effectiveness of the therapy being employed.