重度子痫前期及子痫合并颅脑疾病33例诊治分析

目的探讨重度子痫前期及子痫合并颅脑疾病的病因、临床表现、诊断、治疗原则及预后。方法回顾性分析33例重度子痫前期及子痫合并颅脑疾病住院病人的临床资料。结果33例中CT或MRI检查发现19例脑出血患者,出血量在30ml以下者11例,给予保守治疗。血肿量大于30ml的患者8例,其中出血量超过60ml,并伴脑疝形成的4例,3例行血肿清除术及去骨瓣减压术,1例放弃治疗;其余4例1例行脑室外引流,3例行颅内血肿微创引流术。剖宫产25例,阴道产8例,其中利凡诺引产8例,新生儿死亡5例,死胎6例,其余均存活,存活的最小新生儿胎龄28周,重约685g。8例肾功能不全者经血液透析后6例临床治愈,2例经对症处理后治愈。14例脑梗死患者均给予扩管、小剂量脱水、低分子右旋糖苷等保守治疗,均未手术干预。33例孕妇中恢复良好26例,3例轻、中度偏瘫,2例癫痫,1例不全失语,1例放弃治疗自动出院。结论子痫前期及子痫具有易发生肝肾损害、脑卒中等危险因素,出现神经系统症状时应及时行头颅CT或MRI检查,明确诊断后配以脑卒中相应治疗措施,及时终止妊娠,积极治疗重度子痫前期及子痫。

Diagnosis and Treatment of Severe Preeclampsia and Eclampsia Accompanied with Cerebral Hemorrhage or Infarct (a Report of 33 Cases)

Objective To investigate the cause, clinical manifestation, diagnosis and treatment of pregnancy-induced severe preeclampsia or eclampsia accompanied with cerebral hemorrhage or infarct. Method The clinical data of 33 patients with severe preeclampsia or eclampsia accompanied with cerebral hemorrhage or infarct, who were treated in our hospital, were analyzed retrospectively. Results Of 19 patients with cerebral hemorrhage, 11 with hematoma volume of less than 30 ml were conservatively treated, 4 with hematoma volume ranging from 30 ml to 60 ml were treated respectively by external ventricular drainage （1 case） and hematoma cavity drainage （3 cases）. Of 4 patients with hematoma volume of more than 60 ml, 3 were trreated by evacuation of hematoma and decompressive craniectomy, and 1 was not treated due to family’s demand. Fourteen patients with cerebral infarct were conservatively treated. Stopping of the gestation was performed in all the patients （hysterotomotokia in 25 patients and induced labour in 8 patients）. The twenty-two neonates survived, 5 neonates died and there was dead birth in 6 patients. Of 33 pregnant women, 26 were recovered well, 3 had mild or moderate hemiplegia, 2 had epilepsy, 1 had incomplete aphasia, and 1gave up treatment and was automatically discharged from hospital. Conclusions CT or MRI examination should be performed as early as possible in the pregnant women if the nervous system symptoms appear. The pregnancy should be terminated and the patients should be actively treated in good time if the diagnosis of severe preeclampsia and eclampsia accompanied with cerebral hemorrhage or infarct is confirmed.