26例妊娠合并脑卒中临床分析

Clinical analysis of 26 cases with stroke in pregnancy

目的探讨妊娠合并脑卒中的临床表现、影像学特征、诊治及妊娠结局。方法对2001年1月至2014年6月在宣武医院住院的26例妊娠合并脑卒中患者的临床表现、实验室检查及影像学资料进行回顾分析。结果我院2001年1月至2014年6月共分娩26 494例,出现妊娠合并脑卒中26例,发病率为98.1/10万次分娩;其中出血性脑卒中10例,缺血性脑卒中16例。26例患者均有头痛、恶心症状,20例出现呕吐,9例有意识障碍,10例出现抽搐及视物模糊。预后良好11例,遗留功能障碍12例,放弃治疗自行出院1例,死亡2例。结论妊娠合并脑卒中病情凶险,致死率及致残率高,当孕产妇出现神经症状及体征时,临床医师应考虑脑卒中的可能。尽早行CT、MRI、血管造影等检查确诊,多学科协作制定个性化治疗方案,以取得良好预后。

Objective To investigate the clinical manifestations, imaging examinations, treatments and outcomes of patients with stroke during pregnancy. Methods From January 2001 to June 2014, the clinical manifestations, laboratory examinations and imaging data of 26 patients who suffered from stroke during pregnancy in our hospital were ana- lyzed. Results Approximately 26 494 women gave birth at our hospital, in which 26 patients suffered from pregnancy-re- lated stroke. The incidence rate was 98.1 per 100 000 deliveries. Ten of these women had hemorrhagic strokes and 16 had ischemic strokes. Among the 26 patients, headache and nausea occurred in all cases, vomiting in 20 cases, consciousness disturbance in 9 cases, convulsion and visual blurring in 10 cases. Eleven patients had good prognosis, 12 patients re- mained functionally impaired, 1 patient gave up treatment, and 2 patients died. Conclusion Stroke during pregnancy car- ries high mortality and disability. When pregnant woman appears nerve symptoms and signs, the probability of stroke should be considered. Early diagnosis such as CT, MRI and angiography and personalized therapeutic strategies, multi-discipline collaboration is essential for favorable prognosis.