64例妊娠相关卒中临床特征以及疗效分析

Clinical characteristics and treatment of 64 cases with pregnancy-related stroke

目的总结我院妊娠相关卒中的分型、临床表现、影像学、治疗以及预后特征。方法回顾性分析唐都医院2003~2017年妊娠合并卒中64例患者的临床表现、影像学、治疗以及预后资料。结果所有患者均急性起病,平均发病年龄为27.34岁,产前发病27例,产后发病35例,2例为生产时发病;初产妇29例,经产妇35例。首发临床表现头痛42例、肢体无力24例、抽搐12例、意识障碍12例、视物变形2例。34例颅内静脉窦血栓形成(其中缺血合并出血性卒中12例、出血性卒中6例、缺血性卒中5例、头痛伴或不伴抽搐11例);出血性卒中22例(其中6例脑实质出血,1例脑室出血,3例蛛网膜下腔出血,2例动脉瘤,2例颅内动静脉瘘,1例胸7动静脉瘘,4例烟雾病,3例动静脉畸形);8例脑梗死。所有患者均根据病情给予手术或者保守治疗。其中孕产妇死亡3例,12例引产,死亡或者引产最多的疾病为血管畸形、动脉瘤所致的脑出血。结论妊娠相关卒中发病较急,社会危害大,各种类型卒中预后不同,及早识别以及治疗可能改善患者预后。

Objective We studied the classification,clinical manifestations,imaging,treatment and prognostic features of pregnancy-related stroke in our hospital.Methods We performed a retrospective analysis of the clinical data of 64 cases with pregnancy-related stroke in Tangdu Hospital from 2003 to 2017.Results All patients had acute onset,the average age of onset was 27.34 years,27 cases were prenatal onset,35 cases were postpartum onset,2 cases were prenatal onset and 29 cases were primipara.The first clinical manifestation was headache in 42 cases,limb weakness in 24 cases,epilepsy in 12 cases,consciousness disturbance in 12 cases,and visual deformity in 2 cases.Stroke classification included 34 cases of intracranial venous sinus thrombosis,6 cases of cerebral parenchymal hemorrhage,1 case of ventricular hemorrhage,8 cases of cerebral infarction 3 cases of subarachnoid hemorrhage,2 cases of aneurysm,2 cases of intracranial arteriovenous fistula,1 case of thoracic 7 arteriovenous fistula,4 cases of moyamoya disease and 3 cases of arteriovenous malformation.All patients were given surgery or conservative treatment according to their condition.3 cases of maternal death.The highest death or induced labor diseases were cerebral hemorrhage caused by vascular malformations and aneurysms.Conclusion Pregnancy-related stroke is an acute disease with great social harm.The prognosis of various types of stroke is different.Early identification and treatment may improve the prognosis of patients.