妊娠合并颅内静脉血栓形成12例分析

Analysis of 12 patients with cerebral venous sinus thrombosis during pregnancy and puerperium

目的探讨妊娠合并颅内静脉血栓形成的危险因素、临床特点和母婴结局。方法回顾分析我院2005年1月至2010年1月发生的12例妊娠合并颅内静脉血栓形成患者临床表现及结局。结果 (1)有12例颅内静脉血栓形成,发生比例为0.17‰。重度子痫前期/子痫共1775例。发生颅内静脉血栓形成10例,发生比例为5.63‰。(2)临床特点:发病时间多发于术后24h内。首发症状多为头痛、呕吐、视物不清等颅内压增高表现。依据血栓形成部位不同可引起神经局灶性体征。如抽搐,肌无力,偏瘫,四肢瘫,视力障碍和病理反射征阳性。所有患者CT均为上矢状窦静脉血栓形成。结论妊娠合并颅内静脉血栓形成好发于重度子痫前期/子痫患者,多发生于术后24h内。表现为产科用药难以控制的抽搐应立即行神经影像学检查:如CT,MRI等尽早诊断,尽早治疗。血清D-二聚体、纤维蛋白原、HDL-C检测可能有一定的预测意义。

Objective To explore the clinical features and outcomes of patients with cerebral venous sinus thrombosis（CVT）during pregnancy and puerperium.Methods A retrospective study was performed in 12 cases of pregnant women with CVT among deliveries in our hospital from January 2001 to January 2010,including 2 cases happened during pregnancy and 10 cases during puerperium.The etiology,clinical presentations,imaging examination results,other relevant examinations and pregnant outcomes of these patients were analyzed.Results（1）Incidence of CVT during pregnancy and puerperium was 0.17‰（12/68000）and incidence of CVT in severe preeclampsia /eclampsia was 5.63‰（10/1775）.（2）The time of the patients fell ill was during preoperation to 24 hours after cesarean section.The first symptom mostly was headache,nausea and vomiting or blind.With the different location of CVT,the signs were different,such as hyperspasmia,myasthenia hemiplegia papilledema and positive pathological reflex.All women showed superior sagittal sinus thrombosis by CT examinations.Conclusion The patients of severe preeclampsia/eclampsia often fell in CVT during pregnancy and puerperium.The time of the patients fell ill from preoperation to 24 hours after cesarean section.The first symptoms often were headache,nausea and vomiting or blind.The signs were different,such as hyperspasmia and myasthenia,hemiplegia,papilledema,positive pathological reflex.When obstetric medicine couldn＇t control spasm,we should alert CVT,do the imaging examination such as CT、MR and treat it as early as possible.Plasma D-dimer,Fibrinogen and HDL-C may be used to forecast CVT.