妊娠相关脑卒中合并脑疝的临床分析

目的 总结妊娠相关脑卒中合并脑疝的临床特点,以提高对本病的认识.方法 回顾性分析2004年1月至2007年11月收治的妊娠及产后6个月内妊娠相关脑卒中合并脑疝5例患者的临床资料.结果 5例妊娠相关脑卒中合并脑疝者.确诊脑出血1例.脑动静脉畸形伴脑出血1例,颅内静脉窦血栓形成1例,颅内静脉窦血栓形成或侧裂静脉及Labbe静脉血栓形成伴脑出血2例.3例围生儿或胎儿存活.2例死亡.结论 当孕产妇出现神经症状及体征时.临床医师应考虑脑卒中的可能,急行CT、MRl、血管造影检查确诊,及时手术以挽救母婴生命.     

妊娠相关脑卒中临床病例分析

目的探讨妊娠相关脑卒中的临床表现,研究其发病时间、病因、危险因素与母儿预后的关系.方法回顾性分析1995年7月至2005年6月在本院收治的妊娠相关脑卒中的病例共8例.脑卒中分为脑梗死、脑出血和蛛网膜下腔出血.所有的患者至少有一次CT或MRI检查.结果8例妊娠相关脑卒中的病例,确诊脑出血2例,脑出血伴梗死2例,多发性脑梗死2例,单纯脑梗死2例.均发生在分娩前后,1例合并巨幼红细胞性贫血,叶酸、维生素B12水平明显降低;7例重度子痫前期（子痫）患者,其中3例合并血小板减少,1例有一过性高糖血症,1例合并脑血管畸形.产妇均保守治疗好转出院,围产儿1例胎死宫内,5例早产儿.结论本研究发现妊娠相关脑卒中好发于重度子痫前期（子痫）、脑血管畸形、合并血液疾患及营养状况差的孕产妇,多发生于分娩前后,当出现神经症状及体征时,临床医生应考虑到脑卒中的可能,急行MRI、血管造影、CT确诊.多数孕产妇及时治疗可取得较良好结局.     

妊娠卒中33例临床分析

目的探讨妊娠与卒中之间的关系以及妊娠卒中的病因、发病机制、临床特点及预后。方法对33例妊娠卒中病人进行临床分析。结果导致妊娠卒中的原因复杂多样,其中子痫是主要原因之一;高龄孕妇易发生蛛网膜下隙出血且病死率高;由子痫并发的脑出血预后较差。结论妊娠与卒中具有密切关系;与非妊娠卒中相比,妊娠卒中从病因、发病机制到临床特点都有较大差异。     

高血压脑出血患者初发及再发与其脉压关系的临床研究

目的探讨高血压脑出血患者脉压对脑出血初发及再发的预测价值。方法回顾分析298例高血压脑出血患者的脉压水平,并与同期住院的非脑卒中的高血压病患者150例对照。结果脑出血组与对照组的脉压水平差异有显著性(P<0.05);初发与再发组的脉压和收缩压差异有显著性(P<0.05)。结论脉压增大与高血压脑出血发生有关,是高血压脑出血发生及再发的重要危险因素。     

Malaria in pregnancy

Malaria during pregnancy is a recognised risk factor for maternal and foetal complications and it is endemic in certain areas of our country. Pregnancy also enhances the severity of malaria particularly with P falciparum infestation. The outcome of effects of malaria in pregnancy on the mother and foetus is studied here. This is a prospective observational study conducted in the department of obstetrics and gynaecology of RG Kar Medical College during the period from 1st January 2001 to 31st December 2006. Forty pregnant women with malaria in pregnancy were studied. Another 40 non- pregnant women during the same period were served as control. The maternal complications were compared with the controls and the outcome of pregnancy was studied. There was statistically significant (p < 0.05) increase in the incidence of anaemia, cerebral malaria, renal failure, hepatic failure, hypoglycaemia, hypotension and death in the pregnant women in comparison to non-pregnant women. P falciparum infection was also more during pregnancy. There was also increased incidence of abqrtion, preterm labour, intra-uterine growth restriction and intra-uterine foetal death. Treatment with antimalarial drugs particularly in cerebral malaria does not give good results as there were 12 maternal deaths in this series. Every attempt should be made to prevent malaria during pregnancy by various measures as it is associated with high maternal morbidity and mortality and adversely affects the neonatal outcome.     

Association between maternal psychological status and fetal hemodynamic circulation in late pregnancy

Background The prevalence reported of maternal depression from the first to the third trimester was 7.4％,12.8％,12.0％ respectively,which implies that around one-tenth of pregnant women suffer from psychological disorder during the whole pregnancy.It is assumed that during pregnancy the maternal-fetal circulation unit is also affected by maternal psychological status.The aim of this study is to explore the association between maternal psychological status and fetal dynamic blood flow circulation during pregnancy.Methods We recruited 102 singleton low risk pregnant women between 30 to 33 gestational weeks.The Symptom Checklist-90 （SCL-90） was used to assess maternal psychological status.Ultrasound Doppler was used to measure blood flow changes in maternal-fetal circulation.Pulsatility index （PI） value was measured in umbilical artery （UA）,fetal middle cerebral artery （MCA） and maternal uterine arteries （UTA）.Peak systolic velocity （PSV） was measured in MCA and velocity was measured in umbilical vein （UV）.Statistical analysis was performed with standard nonparametric MannWhitney U tests.Two-tailed P values ＜0.05 were considered statistical significance.Results Of the 102 pregnant women,12 patients show high levels of poor mental health.Women with poor mental health have higher umbilical artery PI values than good mental health patients （P=0.020）.A higher MCA PI value is found in poor mental health patients but this does not reach statistical significance （P=0.053）.Women with hostility show lower placental scores （P=0.030）.Women with somatization demonstrate higher values in UA PI,MCA PI and MCA PSV （P=0.049,0.030 and 0.035 respectively）.A higher MCA PSV value is also found in phobic anxiety patients （P=0.046）.Conclusions Poor mental health during pregnancy is found to have an adverse effect on maternal-fetal circulation.Umbilical artery and fetal cerebral circulation are more sensitive and affected by maternal psychological disorder.     

Strokes among black people in Harare, Zimbabwe: results of computed tomography and associated risk factors

Computed tomography was performed and risk factors evaluated in 100 consecutive adult patients presenting to the two teaching hospitals in Harare with a clinical diagnosis of stroke. The mean age of the patients was 52; only 28 were 65 or older. Non-stroke lesions were found in seven patients and were predicted by a recent history of convulsions (p less than 0.0001). Five lesions (four subdural haematomas and one cerebral cysticercosis) were remediable. Hypertension was present in 27 (93%) of the 29 patients with cerebral haemorrhage and in 49 (53%) of the 93 patients with stroke lesions. In 22 (45%) of these patients the hypertension had not been diagnosed, and another 22 had defaulted from treatment. All 13 patients who died before computed tomography had hypertension, and over half showed evidence of haemorrhagic stroke. There was a cardiac source for all 12 cases of cerebral embolism. In eight of the 100 patients cerebral infarction was attributed to neurosyphilis. None of the patients had clinical evidence of atherosclerosis. Smoking and oral contraceptives did not seem important risk factors for stroke. Detection and control of hypertension remain the most important measures needed to reduce the incidence of and mortality from stroke in Zimbabwe.     

126例青年人脑卒中病因分析

分析青年人脑卒中的病因,提高预防脑卒中的意识。方法：回顾性分析126例14～45岁青年脑卒中患者的病因。结果：青年人脑梗死最主要的病因是脑动脉粥样硬化与脑栓塞,青年人脑出血最常见的病因是脑血管畸形与动脉瘤。结论：探讨青年人脑卒中的病因,对于诊断治疗和预防青年人脑卒中具有重要意义。     

缺血修饰白蛋白临床应用研究进展

缺血修饰白蛋白(IMA)是近年来发现的在急性冠状动脉综合征的早期即可出现的血清标志物。进一步的研究证实IMA是心肌缺血标志物而非心肌损伤标志物,在急诊胸痛患者的危险分层预后评估中具有重要意义。然而,IMA并非急性冠状动脉综合征所特有的标志物,在急性脑卒中、肺梗死、难产、慢性肾性贫血患者甚至正常妊娠妇女中均发现可以升高。本文综述了IMA在各种疾病时的表现及对IMA结果的校正,以便更客观地认识IMA。     

妊娠和产褥期蛛网膜下腔出血11例临床分析

目的探讨妊娠和产褥期蛛网膜下腔出血（SAH）的病因、发病时间、临床特点及预后。方法回顾性分析1995年9月至2009年9月我院收治的11例妊娠和产褥期SAH患者的临床资料。结果本组11例中,初产妇6例,产前9例,孕13～36周,平均孕周（26.11±8.57）周,中期妊娠4例,晚期妊娠5例,产后2例。脑动静脉畸形（AVM）3例,动脉瘤2例,AVM合并动脉瘤1例,子痫2例,静脉窦血栓1例,病因不明确2例。手术治疗3例,γ刀1例,孕妇预后均良好,其中胎儿引产1例;保守治疗7例,其中孕妇死亡4例,胎儿死亡3例。结论 SAH是妊娠和产褥期少见而严重的并发症,多见于晚期妊娠,以动脉瘤和AVM最常见。治疗应以神经外科原则为基础,Hunt-Hess分级低于IV级时应及时神经外科干预。外科干预的时机和分娩方式应根据不同孕周而不同。     

妊娠高血压综合征患者的产前观察及护理

目的:探讨妊娠高血压综合征(妊高征)的护理方法。方法:为84例妊高征患者产前、产后提供安静、舒适的住院环境,从心理护理、病情观察、用药护理等方面实施科学的、有效的护理措施。结果:68例采用剖宫产手术终止妊娠,16例自然分娩,8例并发子痫,2例孕妇因脑栓塞致婴儿死亡。结论:为妊高征患者实施科学的、有效的护理措施,可提高治疗效果及产科质量,减少母婴并发症的发生。     

Predisposing factors, diagnosis, treatment and prognosis of cerebral venous thrombosis during pregnancy and postpartum: a case-control study

Background  Previous investigations have demonstrated a relatively low incidence of stroke among young women, though both pregnancy and delivery can substantially increase the risk. Cerebral venous thrombosis may manifest different characteristics during pregnancy and postpartum as a result of their specific physiological statuses. This study aimed to identify the clinical manifestations, diagnosis, treatment, and prognosis of cerebral venous thrombosis during pregnancy and postpartum.

Methods  We conducted a retrospective analysis of 22 patients with cerebral venous thrombosis who were assigned to either group A (during pregnancy) or group B (during postpartum). The relevant risk factors, initiation and development of the disease, clinical presentations, diagnosis, treatment, and prognosis were compared between the two stages.

Results  Cerebral venous thrombosis occurred during both pregnancy and postpartum, but was more common postpartum. Patients in group A had a longer hospitalization period than those in group B. Confirmed predisposing factors in 85.7% of patients of group A were dehydration, infection, and underlying cerebrovascular disorders. No obvious predisposing factors were identified in group B. The most frequent symptom was headache, with epileptic seizures, hemiparalysis and aphasia being less frequent symptoms. Focal neurological symptoms (P=0.022) and cerebral infarction (P=0.014) occurred more frequently in group A than in group B. Anticoagulation therapy proved to be safe for cerebral venous thrombosis patients during puerperium, regardless of parenchymal hemorrhage. However, more attention should be paid to spontaneous in-site placental hemorrhage in pregnant patients. Both groups had similar prognoses (P=1.000), with 36.3% patients suffering from consequential dysfunction or recurrent intracranial hypertension. Delayed diagnosis was associated with a poorer prognosis.

Conclusions  Cerebral venous thrombosis manifests different clinical characteristics during pregnancy and postpartum, though both have a good prognosis. Early diagnosis and prompt anticoagulation therapy are essential.

     

急性脑卒中患者白细胞反应及临床意义

目的探讨白细胞在急性脑卒中发病中的作用。方法采用全自动血细胞分析仪对患者外周血白细胞进行分类 ,计数 ,并与同年龄对照组进行比较。结果脑卒中患者急性发作时 ,外周血白细胞数量主要是中性粒细胞增高明显 ,尤其以急性脑出血升高最为显著。结论白细胞在急性脑卒中的发生 ,发展中起重要作用。     

237例妊娠期高血压疾病患者母婴结局分析

目的探讨妊娠期高血压疾病与母儿预后的关系。方法对2006年3月至2010年3月我院就诊的237例妊娠期高血压疾病患者的母婴并发症、分娩方式进行回顾性分析。结果胎盘早剥、FGR、围生儿死亡、早产、胎儿窘迫、新生儿死亡率等母婴并发症重度子痫前期组明显高于妊娠期高血压组。结论围产儿预后与妊娠期高血压疾病的严重程度成正比,适时选择剖宫产终止妊娠是重要的治疗措施,对提高母婴的生存率有重要意义。     

脑卒中并发上消化道出血的机制及治疗进展

消化道出血是脑卒中最严重的并发症之一,发病机制不清。急性脑出血并发上消化道出血(UGH)的发生率明显高于急性脑梗死组,病变累及脑干时尤为突出。伴意识障碍的患者并发UGH的发生率较高。脑卒中并发UGH发生时间多在发病后24h内出现,亦可发生于病程10d左右。并发UGH的脑卒中患者病死率明显高于未并发UGH者。脑卒中并发UGH预后不良,早期应采取措施,积极预防。     

低甲状腺素血症与妊娠的研究进展

甲状腺激素是物质代谢与神经智力发育不可缺少的重要物质,妊娠的各个环节均受甲状腺激素的影响。孕母甲状腺功能减退的严重程度与妊娠结局密切相关,即使是孤立性低甲状腺素血症也会对儿童神经智力发育产生不利影响。低甲状腺素血症的发生与孕母碘营养状况密切相关。甲状腺激素随妊娠周期不同而变化,建立妊娠特异的参考值范围可以减少低甲状腺素血症的误诊率和漏诊率。妊娠早期母体低甲状腺素血症是儿童早期认知发育延迟的危险因素,维持孕期正常的甲状腺激素水平对于妊娠结局及胎儿发育有重要意义。     

脑梗死与颈动脉粥样硬化斑块的相关性研究

目的探讨脑梗死与颈动脉粥样硬化斑块的相关性。方法采用彩色多普勒血流成像技术对50例脑梗死患者进行检测,观察其梗死侧和非梗死侧颈动脉内中膜厚度、斑块的部位、大小及其数目、动脉狭窄程度以及血流动力学改变等,并与48例对照组颈动脉粥样硬化斑块检出情况进行比较。结果脑梗死组患者的颈动脉粥样硬化斑块检出率为62%,显著高于对照组(18.7%,P<0.01)。颈动脉粥样硬化斑块多发生在梗死病灶的同侧,占72%,以颈总动脉分叉处居多,占52%。斑块大小及其数量,峰值流速、搏动指数与脑梗死有明显的相关性(P<0.05),而颈动脉内中膜厚度、狭窄程度无明显差异(P>0.05)。结论脑梗死的发生与颈动脉粥样硬化斑块密切相关,防止斑块的形成对防止脑梗死的发生有非常重要的意义。     

代谢综合征与脑卒中危险因素的临床分析

代谢综合征(MS)患者具有较高的心脑血管疾病发病率,胰岛素抵抗(IR)是代谢综合征重要的病理生理改变。本文旨在探讨脑卒中与代谢综合征的关系,以预防脑卒中的发生,从而降低脑卒中发病率,提高生命质量。     

Clinical utilization of microembolus detection by transcranial Doppler sonography in intracranial stenosis-occlusive disease

Objective To discuss the clinical ultiliazation and significance of microembolus detection by transcranial Doppler (TCD) sonography in intracranial stenosis-occlusive disease.Data sources All related a...     

动脉硬化性脑梗死复发的危险因素分析

目的：探讨脑梗死复发的危险因素。方法：随访观察769例脑梗死患者,比较有复发的脑梗死患者和无复发的脑梗死患者首次卒中时的危险因素、血同型半胱氨酸（Hcy）、可溶性黏附分子（SICAM-1）、细胞因子水平、颈动脉粥样硬化的严重程度、狭窄程度及斑块类型、首次卒中后危险因素控制情况。结果：769例脑梗死患者在随访期有156例（占20.3%）复发,出院后正规服阿斯匹林的患者复发率低于未正规服阿斯匹林的患者（P〈0.05）;首次卒中后戒烟者及血压、血糖、血胆固醇控制在正常范围的患者复发率低于控制不好的患者;多变量Logistic回归分析表明,年龄、血清白蛋白/球蛋白比例、血糖、纤溶酶原活性、Hcy、sICAM-1、IL-6水平及颈动脉粥样硬化的严重程度、狭窄程度、斑块类型以及首次卒中后是否戒烟,血压、血糖和血胆固醇是否控制在正常水平,出院后是否正规服用阿斯匹林是脑梗死复发密切相关的危险因素。结论：与脑梗死复发相关的危险因素多,首次卒中后戒烟、控制好血压、血糖和血胆固醇以及出院后正规服用阿斯匹林在降低脑梗死复发中起重要作用。