Treatment of severe pre-eclampsia is carried out during 24-48 hours and the absence of a positive effect is an indication for the completion of pregnancy, since its prolapse in conditions of severe hemodynamic, vollemic and metabolic disorders is impractical and leads to an even worse deterioration of the fetus and the most pregnant one.
I. Strict medical and protective regimen in the intensive care unit with sound and svitloizolyatsiey. Constant monitoring of the level of blood pressure, diuresis, blood indicators, the work of all vital organs and the state of the fetus.
II. Rational protein nutrition with limited use of liquid (up to 600-700 ml, but not more than 1-3
1. Sedation therapy with combined use of tranquilizers (trioksazin 0.6 g 3-4 times a day, sedusxen 10 mg intravenously or intramuscularly), neuroleptics (droperidol 00025-0005 g intramuscularly or intravenously), narcotic analgesics (promedol 2ml 1% solution or predionum 40ml 2.5% solution intravenously slowly) and diphenhydramine in 1 ml of 1% solution.
2. Hypotensive therapy.
Controlled hypotension by magnesium sulfate, depending on the initial level of athereal pressure. With an initial blood pressure of 110-120 mm Hg. it is necessary to administer 30 ml of a 25% solution of magnesium sulfate in 400 ml of rheopolyglucin, at a rate of 100 ml injection of hemodilutant per hour. With blood pressure, within the range of 121-130 mm Hg, the dose of magnesium sulphate should be increased to 40 ml, and with an increase in the SAD index above 130 mm Hg. - And in 50ml of 25% solution. It is not permissible for a sharp drop in blood pressure. Optimal is the reduction of SBP by 10-20 mm Hg. in the first hour of infusion. The ratio of the speed of infusion to the rate of urination should be in the range of 1.5-3.5.
In the absence of the effect of antihypertensive therapy at a blood pressure level of 160-170 /105-110 mm Hg. ganglion blockers are used (pentamine 50 mg in a 5% glucose solution intravenously drip, at a rate of 50 ml for 10 minutes, to decrease the SBP to a level of 125-130 mm Hg, followed by the administration of magnesium sulfate until the parameters stabilize at the normal level.
Against the backdrop of magnesian therapy, it is possible to use other antihypertensive agents - clonidine 1 ml 001% solution 2-3 times a day - combined use of b-adrenoblockers (propranolol, obzidan) and calcium antagonists of nifedipine group, - ACE inhibitors (captopril 6 , 25 mg three times day, - peripheral vasodilators (aprasin, nitroglycerin) - spasmolytics (eufillin 5-10 ml 24% solution intravenously 2-3 times a day, dibasol 2-6 ml 0.5% intravenously with papaverine 2% 2-4 ml intramuscularly 2 -3-times a day) -glucose-novocaine mixtures, intravenously, drip
3. Controlled hypervolemic hemodilution
Initiation of fluid administration follows from low molecular weight dextrans (reopoliglyukin, reogluman) and protein preparations (albumin, plasma). In the future, it is possible to administer crystalloids for the purpose of correcting metabolic disorders by expedient administration of sodium bicorbane (carefully under the control of the acid-alkaline state of the blood!) And polyionic solutions. After correction of hypovolemia - diuretics (lasex for 001-002 g for every 100 ml of intravenously injected liquid).
4. Intensification of the heart: - cardiac glycosides: korglikon, digoxin, calcium antagonists of the verapamil group; - Improvement of metabolism in the myocardium: Riboxin 10% 10ml intravenously; Essentiale 5-10 ml intravenously, diluted preliminary blood of the patient - increasing the ability of cardiomyocytes to synthesize LNG (methionine, potassium orotate, nicotinic, folic acid in a dose, as in the treatment of pre-eclampsia of mild severity
5. Improvement of liver function legalon, Essentiale 1-2 capsules 3 times a day, riboflavin 0.6 mg, pyridoxine 1 ml 5% solution
6. Enterosorbents (activated charcoal 2 tablets 3-4 times a day), hemosorbents SKN-3 , SKN-4M (1 tablespoon 3-4 times a day) two hours before or After ingestion or extracorporeal detoxification by plasmapheresis, 4 to 5 times every other day, 300-500 ml
7. SCS according to the indications for compensating the decreased function of the adrenal cortex, carefully, taking into account the arterial pressure (dexamethasone 4-8 mg in day, hydrocortisone at 005-008 g per day)
8. To improve the cerebral circulation: piracetam 20-25ml 20% solution in 200ml of saline.
9. To prevent the onset of pulmonary insufficiency - oxygen therapy, etazol 1% solution at the rate of 0.5-1 mg per 1 kg of body weight intravenously slowly 1-2 times a day, lobeline hydrochloride 1% 1ml subcutaneously 1-2 times a day.
10. Improve the rheological properties of blood by introducing a reopolyglucin-heparin mixture at a rate of 5-6ml of reopolyglucin and 340 units of heparin per 1 kg of the patient's mass. Half of the calculated mixture of heparin is injected, the rest is subcutaneously every 4-6 hours during the day in equal doses, followed by a gradual decrease in the dose of heparin. To conduct such treatment, a coagulogram should be monitored (an allowable reduction in blood clotting, no more than 2 times compared with the norm ). When symptoms of DIC appear, the reopolyglucin-heparin mixture should be administered with a plasma containing antithrombin III.
11. Antioxidant therapy, prevention of fetal hypoxia, as in the treatment of pre-eclampsia of mild