妊娠期和产褥期颅内静脉窦血栓的临床特点及母儿结局

Clinical Characteristics and Maternal and Fetal Outcomes of the Patients with Cerebral Venous Sinus Thrombosis During Pregnancy and Puerperium

目的探讨妊娠期和产褥期颅内静脉窦血栓(CVST)的临床特点及母儿结局。方法选取2016年1月至2021年12月郑州大学第一附属医院收治的64例妊娠期和产褥期CVST的患者进行回顾性分析研究。结果CVST在产褥期与妊娠期的发生率为5∶3,妊娠期CVST的发病率为98.12/100000;妊娠期CVST患者的病死率(20.8%)高于产褥期(5.0%),但差异无统计学意义(P>0.05);孕产期CVST总体病死率10.3%;妊娠期CVST胎儿丢失率为87.5%(21/24);横窦(79.7%)为最常见的受累部位,其次为乙状窦(62.5%)和上矢状窦(51.6%),48例(75.0%)患者≥2个部位受累;最常见的首发症状为头痛(56例,87.5%)、恶心呕吐(31例,48.4%)、局灶神经功能障碍(30例,46.9%)等,其中恶心呕吐在妊娠期的发生率高于产褥期,差异有统计学意义(P=0.002),头痛、局灶神经功能障碍在妊娠期的发生率高于产褥期,但差异无统计学意义(P>0.05);颅内出血在妊娠期的发生率高于产褥期(P=0.036);脑梗死在妊娠期的发生率高于产褥期,但差异无统计学意义(P>0.05)。死亡人群年龄高于存活组(P=0.008);首发症状为昏迷、合并颅内出血、合并脑梗死、入院时mRS高评分在死亡人群中的比例较高(P<0.05)。多因素logistic回归分析发现首发症状昏迷是预后不良的独立危险因素(OR=17.667,95%CI:2.893~107.88)。结论妊娠期和产褥期CVST临床表现缺乏特异性,易延误诊断与治疗,昏迷为不良预后的独立危险因素,做好预防、早识别、早诊断、早治疗才可获得较好母儿结局。

Objective To describe the clinical characteristics and its effect on maternal and fetal outcomes of the patients with cerebral venous sinus thrombosis(CVST)during pregnancy and puerperium.Methods A total of 64 CVST cases during pregnancy and puerperium in the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2021 were retrospectively reviewed.Results The incidence of CVST in puerperium and pregnancy was 5∶3.The incidence rate of CVST during pregnancy was 98.12/100000.The mortality rate during pregnancy(20.8%)was higher than that during puerperium(5.0%),but the difference was not statistically significant(P>0.05).The overall maternal mortality was 10.3%(7/64)respectively.The fetal mortality was 87.5%(21/24)in pregancy,respectively.Transverse sinus(79.7%)was the most frequently affected location,followed by sigmoid sinus(62.5%)and superior sagittal sinus(51.6%).There were 48 patients more than one sinus involved.The most frequent initial symptom was headache(56,87.5%),nausea/vomiting(31,48.4%),focal neurological deficit(30,46.9%).Nausea/vomiting was more common during pregnancy than during puerperium(P=0.002).Headache and focal neurological deficit were more common during pregnancy than during puerperium,but the difference was not statistically significant(P>0.05).The incidence of intracranial hemorrhage in pregnancy was higher than that in puerperium(P=0.036).The incidence of cerebral infarction in pregnancy was higher than that in puerperium,butthe difference was not statistically significant(P>0.05).The age of the death group was higher than that of survival group(P=0.008).Coma,intracerebral haemorrhage,cerebral infarction,high modified Rankin Scale score before treatment were more common in the death group(P<0.05).Multivariate logistic regression analysis showed that coma at first symptom was an independent risk factor for poor prognosis(OR=17.667,95%CI:2.89-107.88).Conclusion The clinical manifestations of CVST during pregnancy and puerperium are lack of specificity,and it is easy to delay diagnosis and treatment.Coma was an independent risk factor for poor prognosis,and better maternal and infant outcomes can be achieved only by good prevention,early recognition,early diagnosis and early treatment.