妊娠相关脑卒中39例临床分析

Clinical Analysis on 39 Cases of Stroke Related to Pregnancy

目的:探讨妊娠相关脑卒中的发病原因、临床表现、母婴结局、治疗及预防措施。方法:回顾性分析2001年1月-2013年12月我院共收治的妊娠相关脑卒中39例患者的临床资料。结果:39例患者中,发生在妊娠期21例,产褥期18例。经电子计算机断层扫描(CT)、磁共振成像(MRI)、磁共振动脉血管造影(MRA)、磁共振脑静脉血管成像(MRV)、数字减影血管造影术(DSA)和腰椎穿刺等检查明确诊断,诊断出血性脑卒中7例,脑梗死3例,脑静脉窦血栓(CVST)29例,均给予相应的抢救及治疗。16例早期、中期妊娠患者行人工流产术或利凡诺羊膜腔内注射穿刺引产终止妊娠,5例患者行剖宫产终止妊娠。患者治愈出院15例,6例死亡,14例遗留不同程度的肢体活动障碍或语言障碍,家属放弃治疗出院4例。结论:妊娠相关脑卒中危险因素主要包括子痫前期、心源性栓塞、脑血管畸形、脑动脉瘤、水电解质紊乱等代谢障碍性疾病及产褥感染等。其发病急、病死率高,故需提高对本病的认识,定期产前检查,及时发现高危因素,早诊断及时治疗,选择适当的时机及方式终止妊娠是改善妊娠相关脑卒中患者预后的关键。

Objective： To investigate the cause,clinical manifestations, pregnancy outcomes, treatment and preventive measures of stroke related to pregnancy. Methods： Retrospectively analyzed the clinical data of 39 cases of patients with stroke related to pregnancy who were treated in our hospital from January 2001 to December 2013. Results： Among the 39 patients, there were 21 cases of stroke occurred during pregnancy and 18 cases of stroke occurred during puerperium. The computer tomography （CT）, magnetic resonance imaging（MRI）, magnetic resonance angiography（MRA）, magnetic resonance venography（MRV）, digital subtraction angiography（DSA） and lumbar puncture firm diagnosis results showed, there were 7 cases of hemorrhagic stroke, 3 cases of cerebral infarction and 29 cases of cerebral venous sinus thrombosis （CVST）, who were treated with the appropriate rescue and treatment. 16 cases of pregnancy in early and mid stage were terminated pregnancy through artificial abortion or ethacridine amniotic puncture induced labor, and 5 patients were terminated pregnancy through cesarean section. In the end, there were 15 cured, 6 death, 14 patients with sequel of different degree of physical activity disorder or the language disorder, and 4 patients were abandoned treatment by their families. Conclusion： Risk factors of stroke related to pregnancy including preeclampsia, cardiogenic embolism, cerebral vascular malformation, cerebral aneurysm, metabolic disorders （such as water-electrolyte disturbances） and puerperal infection, etc. We should pay attention to this disease due to its acute onset and high mortality, and regularly conduct prenatal examination, in order to discover the risk factors in early stage and timely diagnosis and treat it, choosing the appropriate time and method to terminate pregnancy is the key to improve the prognosis of patients with stroke related to pregnancy.