妊娠合并脑血管病患者临床分析和麻醉处理  

The clinical characteristic and anesthesia management of cerebrovascular disease during pregnancy： a retrospective analysis

作　　者：曾敏[1] 闫婧[1] 董佳[1] 刘晓媛[1] 王联杰 彭宇明[1] 韩如泉[1] Zeng Min;Yea Jing;Dong Jia;Liu Xiaoyuea;Wang Lianjie;Peng Yuming;Hea Ruquea(Department of Anesthesiology, Beijing Tieatan Hospital, Capital Medical University, Beijing 100050, China)

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,100050

出　　处：《国际麻醉学与复苏杂志》2018年第4期346-350,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的分析妊娠合并脑血管病患者的临床特点及麻醉管理经验。方法回顾性分析30例妊娠合并脑血管病患者的临床资料、麻醉管理和治疗转归等。结果妊娠期合并脑血管病患者共30例，其中缺血性脑血管病5例，包括脑梗死3例、静脉窦血栓2例；出血性脑血管病25例，病变类型包括烟雾病4例、子痫前期1例、动脉瘤4例、动静脉畸形13例、海绵状血管瘤3例。剖宫产前神经外科手术治疗5例，剖宫产同期紧急神经外科治疗4例，剖宫产后神经外科手术治疗6例，剖宫产后未进行神经外科处理15例。产科麻醉30例，其中孕中期3例，孕晚期27例（椎管内麻醉16例，全身麻醉11例）。产妇死亡2例，胎儿死亡l例。结论妊娠合并脑血管病的处理，需产科、麻醉科和神经外科密切协作、共同管理。手术时机及麻醉方法的选择需要综合考虑患者神经系统症状、颅内病变类型（血肿大小、部位）、孕龄、胎儿成熟度以及妊娠意愿，权衡利弊，适时终止妊娠并进行神经外科手术处理，改善母胎结局。Objective To investigate the clinical characteristic and anesthesia management in patients with pregnancy complicated with cerebrovaseular disease. Methods We reviewed the clinical data, anesthesia management and outcome of pregnant women with cerebrovascular disease retrospectively from June 2010 to December 2017 in Beijing Tiantan Capital Medical University. Results A total of 30 cases of pregnant women with cerebrovascular disease were collected, including 5 cases of ischemic cerebrovaseular disease： 3 cases of cerebral infarction, 2 cases of cerebral venous sinus thrmnbosis, 25 cases of hemorrhagic cerebrovascular disease, 4 cases of moyamoya, 1 case of preeelampsia, 4 cases of aneurysms, 13 cases of arteriovenous malformations, 3 cases of arteriovenous vascular malformation. Five cases underwent neurosurgery before cesarean section. Four cases of caesarean section during the same period of emergency neurosurgy, 6 cases of caesarean section after neurosurgery, and 15 cases of non- neurosurgical treatment after caesarean section. Thirty cases of obstetric anesthesia, including 3 cases in the second trimester and 27 cases in the second trimester, 16 cases of spinal anesthesia, 11 cases of general anesthesia. Two cases resulted in maternal death, 1 case resulted in fetal death. Conclusions The management of cerebrovascular diseases in pregnancy should be closely coordinated and managed by obstetrician, anesthesiologist and neurosurgeon. The patient＇s neurological symptoms, intracranial lesions （hematoma size, site）, gestational age and fetal maturity, as well as the desire of pregnancy should be fully evaluated to timely terminate pregnancy and neurosurgical intervention and improve maternal fetal outcome.

关 键 词：妊娠 脑血管病 麻醉 

分 类 号：R614[医药卫生—麻醉学]