严重妊娠高血压疾病颅脑影像学变化及预后  

Changes of cranial images and prognosis of severe hypertensive disorder complicating pregnancy

作　　者：王英兰[1] 苏放明[1] 魏晓萍[1] 郭晓辉[2] 周泱阳[2] 韦金喜[2] 

机构地区：[1]暨南大学附属第二临床医学院深圳市人民医院产科,广东深圳518020 [2]暨南大学附属第二临床医学院深圳市人民医院放射科,广东深圳518020

出　　处：《中国妇幼健康研究》2012年第3期346-348,共3页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨严重妊娠高血压疾病的颅脑影像学变化及特征，分析并发脑血管病变的临床高危因素。方法回顾性分析我院近8年来100例重度子痫前期及子痫患者的颅脑CT及临床资料。①根据入院诊断分为：子痫组，43例；重度子痫前期组，57例；②根据颅脑CT结果分为3组：出血组7例；缺血组47例；无异常组46例。结果子痫组脑缺血率为76．8％（33／43），高于重度子痫前期组24．6％（14／57）（Х^2=26．739，P〈0．01）；两组颅内出血率无明显差异（F=0．113，P〉0．05）。出血组平均动脉压156．0±22．4mmHg，高于缺血组133．6±19．9mmHg（t=2．731，P〈0．01）及无异常组136．1±19．9mmHg（t=2．416．P〈0．05）。血清乳酸脱氢酶含量出血组及缺血组均明显高于无异常组（z值分别为2．435、2．327，均P〈0．05）。出血组并发弥散性血管内凝血及HELLP综合征的发生率为42．9％，明显高于缺血组的10．6％（Х^2=5．011，P〈0．05）。预后：死亡2例；植物人状态1例，2例脑缺血患者遗留视力减退。结论子痫组比重度子痫前期组患者颅脑异常的发生率高。当平均动脉压接近156mmHg左右、乳酸脱氢酶异常增高及合并HELLP综合征、弥散性血管内凝血患者应警惕颅内出血发生。严重脑缺血或颅内出血患者预后不良。Objective To study the changes and characteristics of cranial imaging in severe hypertensive disorder complicating pregnancy and analyze the clinical high-risk factors of cerebral vascular diseases. Methods Retrospective analysis of the clinical data and CT cranial images of 100 cases of severe preeclampsia and eclampsia hospitalized in the hospital during last 8 years was conducted. According to the admitting diagnosis they were divided into eclampsia group （ n = 43 ） and severe preeclampsia group （ n = 57 ）. They were also divided into three groups according to cranial CT results ： hemorrhage group （ n = 7 ）, ischemia group （ n = 47 ） and normal group （ n = 46）. Results The rate of cerebral ischemia in eclampsia group was 76. 8% （ 33/43 ）, which was higher than that （ 24. 6%, 14/57 ） in severe preeclampsia group （X2 = 26. 739, P 〈 0.01 ）. There was no statistical diference in intracranial hemorrhage rate between two groups （ F = 0.113, P 〉 0.05 ）. The mean arterial pressure in hemorrhage group was 156.0± 22.4mmHg, which was higher than that （133.6 ± 19.9 mmHg） in ischemia group （t=2.731,P〈0.01） and that （136.1±19. 9mmHg） in normal group （t=2.416,P〈0.05）. TheLDHin hemorrhage group and ischemia group was significantly higher than that in normal group （Z value was 2. 435 and 2.327, respectively, both P 〈0.05）. The rate of complications of DIC and HELLP syndrome in hemorrhage group was 42.9% , which was obviously higher than 10.6% in ischemia group （X2 = 5.011, P 〈 0.05 ）. Two patients were dead and 1 patient became persistent coma. Two patients had visual decreases. Conclusion Eclampsia patients have higher rate of abnormal changes in brain than severe preeclampsia patients. If the MAP is about 156mmHg, or LDH increases significantly or complicating HELLP syndrome or DIC, intracranial hemorrhage should be considered. The prognosis of serious hemorrhage or ischemia is poor.

关 键 词：妊娠期高血压疾病 子痫前期 子痫 颅脑 计算机断层扫描 

分 类 号：R714[医药卫生—妇产科学]