妊娠和产褥期蛛网膜下腔出血11例临床分析

Subarachnoid hemorrhage during pregnancy and puerperium: a clinical analysis of 11 patients

目的探讨妊娠和产褥期蛛网膜下腔出血(SAH)的病因、发病时间、临床特点及预后。方法回顾性分析1995年9月至2009年9月我院收治的11例妊娠和产褥期SAH患者的临床资料。结果本组11例中,初产妇6例,产前9例,孕13～36周,平均孕周(26.11±8.57)周,中期妊娠4例,晚期妊娠5例,产后2例。脑动静脉畸形(AVM)3例,动脉瘤2例,AVM合并动脉瘤1例,子痫2例,静脉窦血栓1例,病因不明确2例。手术治疗3例,γ刀1例,孕妇预后均良好,其中胎儿引产1例;保守治疗7例,其中孕妇死亡4例,胎儿死亡3例。结论 SAH是妊娠和产褥期少见而严重的并发症,多见于晚期妊娠,以动脉瘤和AVM最常见。治疗应以神经外科原则为基础,Hunt-Hess分级低于IV级时应及时神经外科干预。外科干预的时机和分娩方式应根据不同孕周而不同。

Objective To explore the aetiology, timing, clinical features and the prognosis of subarachnoid hemorrhage in pregnancy and puerperium. Methods From Sep 1995 to Sep 2009, 11 cases of subarachnoid hemorrhage in pregnancy or 6 weeks around delivery were analyzed retrospectively. Results The mean maternal age was 25.82±6.26 years old （19 37 years old）, six cases were in primipara, nine cases were in antepartum period and two cases were in postpartum stage. Five patients were in the third gestational trimester, four were in the second. Aneurysms and AVM were responsible for SAH in six patients, two cases were eclampsia, one had venous sinus thrombosis, two had unidentified cerebral vascular malformation. Four cases were treated surgically, including one with gamma knife, in which Maternal and fetal prognosis were good, except one cases of fetal abortion. Seven cases were received conservative treatment,of which four cases were ended with maternal death, three cases were ended with fetal death. Conclusions SAH is a rare and dangerous complication of pregnancy and puerperium. It is most usually caused by cerebral aneurysms and AVM and the decision to operate should be based upon neurosurgical principles, especially those with Hunt-Hess grade below Ⅳ. The timing of surgery and the method of delivery should be different based on different gestational age.