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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 causes of stroke, clinical manifestations, maternal and infant outcomes, treatment and preventive measures. Methods: The clinical data of 39 patients with pregnancy-related stroke who were treated in our hospital from January 2001 to December 2013 were retrospectively analyzed. Results: Among the 39 patients, 21 cases occurred in pregnancy and 18 in puerperium. The results of computerized tomography (CT), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), magnetic resonance imaging of cerebral venous angiography (MRV), digital subtraction angiography (DSA) and lumbar puncture Diagnosis and diagnosis of hemorrhagic stroke in 7 cases, 3 cases of cerebral infarction, cerebral venous sinus thrombosis (CVST) in 29 cases, were given the appropriate rescue and treatment. Twenty-six patients with early or mid-term pregnancy underwent abortion or rivanol by intra-peritoneal injection and abortion. Five patients underwent cesarean termination of pregnancy. The patients were cured and discharged in 15 cases, 6 died, 14 cases left with varying degrees of physical activity disorder or language disorder, and 4 cases were given up for treatment. Conclusion: The risk factors of pregnancy related stroke include metabolic disorders such as preeclampsia, cardioembolism, cerebrovascular malformations, cerebral aneurysm, water and electrolyte disorders and puerperal infection. The incidence of acute and high mortality, it is necessary to improve the understanding of the disease, regular prenatal care, timely detection of risk factors, early diagnosis and timely treatment, select the appropriate timing and manner termination of pregnancy is the key to improving the prognosis of pregnancy-related stroke patients .