具有中枢神经表现的妊娠高血压综合征47例分析

Cerebrovascular Disorders Complicating Pregnancy and the Puerperium: a Study of 47 Patients with Pregnancy Related Hypertension

目的与方法 :回顾分析复旦大学附属中山医院自 1992年来收治合并神经系统异常表现的妊高征患者的病史资料 4 7例 ,按照 1983年制订的妊高征诊断及分类标准分为轻度组 (14例 )和重度组 (即先兆子痫或子痫 ,33例 )。对两组患者的年龄、基础血压值、出现妊高征时的孕龄、中枢神经症状表现、出现中枢异常时的血压值及其与基础血压差值、产后血压恢复正常的时间等指标进行分析。结果 :两组患者中枢神经症状主要表现为头痛和头晕 ,重度组中 7例表现子痫 ,其中 3例来自郊区 ,几乎无正规产前检查。两组患者的年龄、基础血压、妊高征时孕周及产后血压恢复正常的时间均无显著差异 (P >0 .0 5 )。但是两组患者出现中枢异常时的血压 (包括收缩压和舒张压 )、与其基础血压间的差值有显著差异 (P <0 .0 5 )。结论 :妊高征期中枢异常表现严重程度通常和血压的显著增高相关 ,子痫常发生在不注意正规产前检查的患者中。对妊高征患者的早期监护和治疗可减少严重的中枢并发症的发生。本组患者虽无脑卒中的发生 ,但是对孕产妇的头颅影象学及其血液系统高凝倾向的检查可能会使我们有更多的阳性发现。

Background and purpose: The incidence of stroke during pregnancy and puerperium varied from 3.8 to 62.5 strokes per 100,000 deliveries per year in western countries. Our purpose was to investigate the cerebrovascular problems encounted in pregnancy and the puerperium. Methods: Retrospectively analysized 47 patients with pregnancy related hypertension for the period 1992 to 2003. Results: The blood pressures of 33 patients were higher than 21.3/14.6Kpa, within which 7 were diagnosed as eclampsia. The other 14 patients also had a high blood pressure which were higher than 17.3/12Kpa but lower than 21.3/14.6Kpa. All the patients had headache or dizziness with or without vomiting. No obvious stroke attack was found in all the patients. The funduscopic appearances had no significant difference between the two groups. Conclusion: Control of the hypertension promptly during pregnancy is an effective conduct in preventing the pregnancy related cerebrovascular problems. With more advanced technologies such as CT or MRI and coagulation tests, some undetectable central nervous abnormalities might be discovered.