CAJ | 학술논문

目的研究妊娠期出血性脑血管病的临床特点、转归和治疗对策,分析不同治疗手段的利弊.方法对1997年1月至2012年12月就诊于首都医科大学附属北京天坛医院妇产科的76例妊娠期出血性脑血管病患者的临床资料进行回顾性分析.根据治疗方法将其分为手术治疗组和保守治疗组,比较组间患者的临床特点和转归.结果妊娠期脑出血患者共76例,其中病因为动静脉畸形30例,动脉瘤8例,烟雾病8例,子痫前期16例,海绵状血管畸形4例,静脉窦血栓4例,病因不明6例.格拉斯哥昏迷评分(GCS)15～11分54例,10 ～6分6例,5～0分16例.手术治疗40例,保守治疗36例.产妇死亡24例,胎儿胎死宫内4例,新生儿死亡28例.手术治疗组和保守治疗组的临床特征和母婴预后差异无统计学意义(P＞0.05).结论妊娠期出血性脑血管病的处理应先终止妊娠,再评估病情,根据评估结果制定治疗方案,有效降低孕产妇及围产儿病死率.有脑血管病史产妇应在孕期加强监护,并在妊娠足月后及时终止妊娠,以全麻剖宫产为宜,并同时做好新生儿抢救的准备.
목적 연구임신기출혈성뇌혈관병적림상특점、전귀화치료대책,분석불동치료수단적리폐.방법 대1997년1월지2012년12월취진우수도의과대학부속북경천단의원부산과적76례임신기출혈성뇌혈관병환자적림상자료진행회고성분석.근거치료방법장기분위수술치료조화보수치료조,비교조간환자적림상특점화전귀.결과 임신기뇌출혈환자공76례,기중병인위동정맥기형30례,동맥류8례,연무병8례,자간전기16례,해면상혈관기형4례,정맥두혈전4례,병인불명6례.격랍사가혼미평분(GCS)15～11분54례,10 ～6분6례,5～0분16례.수술치료40례,보수치료36례.산부사망24례,태인태사궁내4례,신생인사망28례.수술치료조화보수치료조적림상특정화모영예후차이무통계학의의(P＞0.05).결론 임신기출혈성뇌혈관병적처리응선종지임신,재평고병정,근거평고결과제정치료방안,유효강저잉산부급위산인병사솔.유뇌혈관병사산부응재잉기가강감호,병재임신족월후급시종지임신,이전마부궁산위의,병동시주호신생인창구적준비.
Objective We studied the clinical characteristics of perinatal cerebral haemorrhage,the clinical features of different treatment methods,and patients with different causes,and to investigate the treatment approaches to perinatal cerebral haemorrhage.Methods The clinical data of 76 patients with perinatal cerebral haemorrhage were retrospectively analysed.These patients were treated at Beijing Tiantan Hospital,Capital Medical University between January 1997 and December 2012.They were divided into surgery and conservative treatment groups.Results Paticnts with perinatal cerebral haemorrhage were relatively young.Of the 76 total patients,60 were ≤25 years old,including 6 patients who were 19 years old,which suggests that patients with perinatal cerebral haemorrhage were younger than the general cerebral haemorrhage population.The mortality rate was 32％ among this young population,.the causes of cerebral haemorrhage included 30 cases of arteriovenous malformation (AVM),16 cases of preeclampsia,8 cases of aneurysm (AN),8 cases of moyamoya disease (MMD),4 cases of cavernous haemangioma,4 cases of venous sinus thrombosis,and 6 case of unknown reasons.The average Glasgow coma score (GCS) of patients on admission was 11.8 ±4.5,GCS 15-11 included 54 cases,GCS 6-10 included 16 cases,GCS 0-5 included 16 cases.The onset of cerebral haemorrhage caused occurred at an earlier gestational age (27.8 ± 9.1 weeks),primarily during mid-pregnancy;this result might be related to an intolerance of cerebrovascular diseases caused by the changes of blood volume and cerebral blood flow that occur during the second trimester,including arteriovenous malformation,aneurysm and cavernous haemangiomas.Of 76 total cases of perinatal cerebral haemorrhage,24 resulted in maternal death,4 resulted in intrauterine death,and 28 resulted in neonatal death.The clinical characteristics and maternal and perinatal prognoses of the surgery group did not significantly differ from the conservative group(P ＞ 0.05).The mortality rates between the two groups did not differ (P =0.15).Conclusions Pregnancy complicated with hemorrhagic stroke should first terminate the pregnancy and then,neurosurgical treatment should be performed.Patients with a history of cerebrovascular disease should be in intensive care during pregnancy,and terminate pregnancy in a timely manner.General anesthesia is appropriate for cesarean section.At the same time it should prepare well for neonatal rescue.