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.

Clinical analysis of stroke related to pregnancy

Objective This study aimed to analyze the clinical manifestations of stroke related to pregnancy,with emphasis on the relationship between the timing,etiology,risk factors and the maternal and fetal outcomes.Methods From July 1~(st) 1995 to June 30~(th) 2005,patients with stroke during pregnancy or within 6 weeks of delivery were recruited in our hospital.Stroke was classified as cerebral infarction(CI),intracerebral hemorrhage(ICH),and subarachnoid hemorrhage(SAH).All patients were investigated with at least a CT or MRI scan.Results 8 patients from a total 13625 deliveries with a diagnosis of stroke were identified,including 2 with ICH,2 with ICH and CI,2 with multiple CI and 2 with simple CI.All strokes occured in the 3rd trimester or puerperium.7 preeclampsia or eclampsia cases,among which 3 with thromobocytopenia,1 with the cerebral vessel malformation,1 with transient hyperglycemia.Another patient was diagnosed with macrocytic anemia,with low folic acid and vitamin12 level.All patients discharged with the conservative treatment.There were one fetal death and five preterm deliveries.Conclusions Associated risk factors of stroke related to pregnancy were preeclampsia/eclampsia,cerebral vessel malformation,hematological diseases and poor nutritional condition.All strokes occurred in the 3rd trimester and puerperium.Whenever the neurological symptoms and signs presented,the clinicians should think of the stroke and make confirmed diagnosis by CT,MRI or angiography.Proper management in time will achieve the best outcome for the mother and fetus.