摘要
目的:探讨妊娠中期合并神经系统疾病的临床特点、诊断、治疗方法和妊娠结局。方法:回顾性分析首都医科大学宣武医院近十年收治的妊娠中期合并神经系统疾病21例患者的临床及随访资料。结果:妊娠合并脑损害18例:其中癫痫4例,颅内静脉窦血栓3例,脑血管动静脉畸形2例,脑血管动脉瘤2例,脑梗死2例,病毒性脑炎2例,急性炎性脱髓鞘性脑脊髓炎3例;妊娠合并脊髓损害:脊髓动静脉畸形2例;妊娠合并神经肌肉接头损害:重症肌无力1例。临床症状主要表现为头痛、恶心、呕吐、抽搐、严重者出现癫痫持续状态,下肢麻木、四肢无力等。入院后患者行脑电图(EEG)、电子计算机断层扫描(CT)、磁共振成像(MRI)、磁共振脑静脉血管成像(MRV)、脑血管造影(DSA)和腰椎穿刺等检查明确诊断后,针对不同种类的神经系统疾病进行相应的抢救处理,孕妇存活19例;放弃治疗出院1例,失访;母婴死亡1例。存活的19例患者中,终止妊娠17例,其中12例行依沙吖啶羊膜腔穿刺引产,4例药物流产,1例剖宫取胎术;2例维持妊娠至足月剖宫产,新生儿均存活,随访良好。2例遗留功能缺损。结论:妊娠中期合并的各种类型神经系统疾病病情凶险,应争取尽早诊断,选择合理治疗方法确保孕妇安全。待病情平稳,综合评价引产的必要性后及时终止妊娠,并选择对孕妇安全的引产方式。
Objective：To investigate the clinical characteristics,diagnosis,treatment,outcome of pregnancy in second trimester among pregnant women （ 14 - 27w） with nervous system diseases. Methods： The clinical data of 21 pregnant women in second trimester with nervous system diseases who were treated in Xuanwu hospital in nearly 10 years were retrospectively analyzed. Results： Among the 21 patients, 18 patients were complicated with brain damage, in which 4 patients with epilepsy,3 with intracranial venous sinus thrombosis,2 with vascular malformations,2 with intracranial aneurysms,2 with cerebral infarction,2 with encephalitis,3 with acute inflammatory demyelinatiny encephalomyelitis,2 with Spinal cord arteriovenous malformation,1 with myasthenia gravis. The main clinical features were： headache, nausea, vomiting, convulsion, even status epilepticus, numbness,general fatigue. After diagnosis by examination such as EEG, CT, MRI, MRV, DSA, and so on, and corresponding treatment according to the type of nervous system, among the 21 patients, 19 are alive,and out of them 1 is discharged,out of them 1 died. 2 cases remain functionally impaired. 12 routine in ethacridine totally amniotic cavity induced puncture,4 cases of drug abortion, 1 case accepted the caesarean section. 2 cases maintain pregnancy to term cesarean section technique, the newborn live. Conclusions： The patients in second trimester complicated with nervous system diseases should be payed special attention, diagnosed as soon as possible and treated actively. For the mother＇s safety,termination of pregnancy should be conducted after evaluation of the necessity of middle induced labor after stabilizing the condition of nervous system diseases,and the safe method shouled be choosed to terminate the pregnancy.
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2013年第2期120-123,共4页
Journal of Practical Obstetrics and Gynecology
关键词
妊娠中期
神经系统疾病
引产
致残率
Pregnancy in second trimester
Nervous system diseases
Termination of pregnancy
Disability rate
