重度子癎前期发生可逆性后部白质脑病综合征3例(附文献复习)  

Reversible Posterior Leukoencephalopathy Syndrome in Severe Pre-eclampsia Patients:Three Cases Report(Literature Review)

作　　者：刘子凡[1] 许治强[1] 陈敦金 匡永锋[1] 关海涛[1] 

机构地区：[1]广州医学院第三附属医院神经内科 [2]广州市重症孕产妇救治中心,510150

出　　处：《中国临床神经科学》2011年第5期481-488,共8页Chinese Journal of Clinical Neurosciences

摘　　要：目的:探讨重度子癎前期发生可逆性后部白质脑病综合征(RPLS)的临床表现及治疗原则。方法:对3例重度子癎前期发生RPLS患者的临床症状、体征、实验室和影像学检查、治疗和预后资料结合6例文献报道进行分析。结果:患者均急性发病,常表现为头痛、视朦和皮质盲。平均动脉压急性升高至130mmHg(1mmHg=0.133kPa)左右时发生RPLS,病灶以枕、顶叶为主。9例患者中4例并发HELLP综合征。经积极治疗,患者症状、体征迅速改善,预后良好。结论:①颅内高压和皮质盲是重度子癎前期发生RPLS时的主要临床表现;②重度子癎前期患者脑血管自动调节机制的上限血压下移,血管内皮功能受损明显;③及时终止妊娠和积极降压、脱水是治疗成功的关键。Aim：To study the clinical manifestation and treatment algorithm for reversible posterior leukoencephalopathy syndrome（RPLS） in severe pre-eclampsia patients.Methods：The symptoms,signs,laboratory and imaging examination,treatment and prognosis of 3 severe pre-eclampsia patients who developed RPLS were analyzed with 6 cases literature review.Results：The onset of symptoms was acute in all patients.Headache,blurred vision and cortical blindness were common.RPLS developed when mean arterial blood pressure rapidly rose to around 130 mmHg.Lesions were mainly in occipital lobes and parietal lobes.Four cases were complicated by HELLP syndrome.The symptoms and signs were relieved after active treatment,and patients had a good prognosis.Conclusion：Intracranial hypertension and cortical blindness are the main clinical manifestation of RPLS in severe pre-eclampsia patients.In severe pre-eclampsia patients,the upper limits of cerebral blood flow auto regulation were downshifted and vascular endothelial function was impaired significantly.Termination of pregnancy￡？active dehydration and antihypertensive therapy are keys to successful management of the illness.

关 键 词：重度子癎前期 可逆性后部白质脑病综合征 临床表现 

分 类 号：R741.245[医药卫生—神经病学与精神病学] R742[医药卫生—临床医学]