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目的:探讨妊娠期及产褥期并发脑卒中的病因、临床表现与诊断治疗。方法:回顾分析1993年1月至2010年6月本院收治的妊娠期及产褥期并发脑卒中11例患者的临床资料。结果:18 873例分娩孕产妇中,11例妊娠期及产褥期并发脑卒中,7例出血性脑卒中(3例颅内出血,3例蛛网膜下腔出血,1例脑室出血),4例缺血性脑卒中(1例动脉瘤血栓形成伴脑梗死,3例多发性脑梗死)。最常见的症状为头痛、恶心、呕吐、视物模糊、意识障碍,肢体活动障碍等,体格检查阳性结果多为血压增高,瞳孔改变,肌张力异常,病理征阳性等。11例孕产妇中6例重度子痫前期/子痫患者(其中1例合并血小板减少,3例合并胎盘早剥),3例动脉瘤,1例动静脉血管畸形,1例妊娠期血小板减少合并巨幼红细胞贫血。2例行血肿清除术,2例行脑室引流术,1例行DSA下介入栓塞治疗,6例行内科保守治疗。11患者中7例行剖宫产,1例经阴道分娩,1例晚期流产、1例治疗性引产,1例患者未终止妊娠死亡。2例孕产妇死亡,9例孕产妇治疗好转出院。围产儿5例足月儿,4例早产儿(均为低出生体重儿,其中1例轻度窒息,1例重度窒息,1例引产后死亡)。结论:重度子痫前期/子痫和脑血管畸形是妊娠期及产褥期并发脑卒中的最主要原因。卒中发病症状不特异,对于缺血性脑卒中,病理征多延迟出现,及时的CT、MR、血管造影有助于确诊。积极的神经外科治疗对于出血性脑卒中的孕产妇可能是有益的。对于脑卒中的孕妇终止妊娠的方式和时机需个体化、人文化对待。
Objective: To investigate the etiology, clinical manifestations and diagnosis and treatment of stroke complicating pregnancy and puerperium. Methods: The clinical data of 11 patients with gestational and puerperal complicated stroke in our hospital from January 1993 to June 2010 were retrospectively analyzed. RESULTS: Out of 18 873 pregnant women giving birth, 11 had gestational and puerperium complicated by stroke, 7 had hemorrhagic stroke (3 with intracranial hemorrhage, 3 with subarachnoid hemorrhage, 1 with ventricular hemorrhage) and 4 with ischemia Stroke (1 case of aneurysm thrombosis with cerebral infarction and 3 cases of multiple cerebral infarction). The most common symptoms of headache, nausea, vomiting, blurred vision, disturbance of consciousness, physical activity disorders, physical examination positive results are mostly high blood pressure, pupil changes, abnormal muscle tone, positive pathological signs. Six of 11 pregnant women with severe preeclampsia / eclampsia (1 with thrombocytopenia, 3 with placental abruption), 3 with aneurysms, 1 with arteriovenous malformations and 1 with gestational thrombocytopenia Megaloblastic anemia. 2 cases of hematoma removal, 2 cases of intraventricular drainage, 1 case underwent DSA interventional embolization, 6 cases of conservative treatment. Seven of 11 patients underwent cesarean delivery, one was delivered vaginally, one was aborted late and one was treated with induced abortion. One patient did not terminate the pregnancy. Two cases of maternal death, nine cases of maternal treatment improved discharged. 5 perinatal infants and 4 premature infants (all with low birth weight, 1 mild asphyxia, 1 severe asphyxiation and 1 death after induction of labor). Conclusions: Severe preeclampsia / eclampsia and cerebrovascular malformations are the most common causes of stroke complicated by pregnancy and puerperium. Stroke symptoms are not specific, for ischemic stroke, pathological signs and more delay, timely CT, MR, angiography contribute to the diagnosis. Positive neurosurgical treatment may be beneficial for pregnant women with hemorrhagic stroke. Pregnant women for stroke termination of pregnancy and the timing of the need for individualized, cultural treatment.