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妊娠或分娩期可伴有心肌病,但不常见。本文作者报告1例,以脑栓塞作为围产期心肌病的首发症状。患者30岁,右利,因先兆子痫于妊娠第40周在腰麻下行剖腹产术,取出婴儿正常。6小时后出现右上、下肢麻木,无力,次日晨出现呐吃,发作前无任何一过性神经症状。既往无高血压、心脏病,风湿热等病史。查体:血压130/70,脉搏96次,常有早搏,呼吸18次,心脏向锁骨中线偏左移位2 cm,在心尖部很容易听到 S_4奔马律,内科其它情况基本正常。语言呐吃,但构音,诵读,重复尚正确。颅神经正常,入院当天脑血管造影显示左胼周动脉闭塞,左大脑中动脉分枝闭塞,由栓子引起。入院第14天 CT 扫描显示左大脑前动脉区有一低密度梗塞区。心电图为正常窦性心律,心前导联 S 波深大,Ⅰ导,AVL,V_5,V_6T波低平,其它实验室检查均正常。用地高辛与肝素治疗后,神经症状渐改善,但仍有心动过速和室性异位节律,用奎尼丁,盐酸普鲁卡因酰胺未能很好控制,
Pregnancy or childbirth may be associated with cardiomyopathy, but not common. The authors report a case of cerebral embolism as the first symptom of perinatal cardiomyopathy. The patient, age 30, dextromethorphan, was given a caesarean section at the 40th week of pregnancy due to preeclampsia and the baby was removed. 6 hours after the emergence of upper right, lower limb numbness, weakness, abercrombie and fitch, the next morning na eat, without any transient neurological symptoms before the attack. No previous history of hypertension, heart disease, rheumatic fever. Physical examination: blood pressure 130/70, pulse 96 times, often premature beats, breathing 18 times, the heart shifted to the left side of the midline of the clavicular 2 cm, at the apex is easy to hear S_4 Benma law, other medical conditions were normal. Language na, but accent, reading, repeating is still correct. Normal cranial nerves, cerebral angiography on the day of admission showed left circumflex artery occlusion, left middle cerebral artery occlusion, caused by emboli. On the 14th day of admission, CT scan showed a low-density infarction area in the left anterior cerebral artery area. Electrocardiogram for normal sinus rhythm, anterior S lead deep, Ⅰ lead, AVL, V_5, V_6T wave low, other laboratory tests were normal. After digoxin and heparin treatment, neurological symptoms gradually improved, but there are still tachycardia and ventricular ectopic rhythm, with quinidine, procainamide hydrochloride is not well controlled,