剖宫产术后脑卒中11例分析  

Analysis of 11 cases of stroke after cesarean section

作　　者：张乃羚[1] 董旭东[1] 盖雪松[2] Zhang Nailing;Dong Xudong;Gai Xuesong(Department of Obstetricsthe First People's Hospital of Yunnan Province,Kunming Yunnan 650032,P.R.China;Department of Rehabilitation Medicine,the First People's Hospital of Yunnan Province,Kunming Yunnan 650032,P.R.China)

机构地区：[1]云南省第一人民医院产科,云南昆明650032 [2]云南省第一人民医院康复医学科,云南昆明650032

出　　处：《中国计划生育和妇产科》2023年第9期96-99,共4页Chinese Journal of Family Planning & Gynecotokology

基　　金：国家自然科学基金项目(项目编号:82160442)。

摘　　要：目的分析剖宫产术后脑卒中的临床特点及诊治要点,改善孕产妇妊娠结局。方法回顾性分析云南省第一人民医院2016年1月至2022年8月剖宫产术后脑卒中11例患者的临床资料,探讨其发病原因及高危因素。结果11例脑卒中患者中高龄(≥35岁)5例,占45.45%(5/11);妊娠期糖尿病5例,占45.45%(5/11);孕前肥胖(BMI≥28 kg/m2)4例,占36.36%(4/11);体外受精胚胎移植受孕3例,占27.27%(3/11);分娩方式均为剖宫产,麻醉方式为腰麻或腰硬联合麻醉,始发症状均为术后1~5 d出现不同程度的头痛,11例中9例患者起初都考虑为椎管内麻醉后低颅压性头痛,经去枕平卧、补充等渗盐水、对症处理后症状不缓解,直至治疗3~8 d后患者出现抽搐、偏瘫、语言障碍,方通过影像学检查诊断为脑卒中。11例患者发病6个月后,不良预后者占36.36%(4/11),包括死亡1例,3例存留不同程度的智力和肢体活动障碍。结论当患者剖宫产术后出现新发头痛,应结合患者是否合并妊娠期高血压疾病、妊娠期糖尿病、高龄、肥胖等高危因素及麻醉方式,仔细观察头痛出现的特点及伴发症状,仔细地从意识、状态、颅神经、运动系统、神经系统等多方面进行检查;如排除椎管内麻醉导致的硬脊膜穿破后头痛(post-dural puncture headache,PDPH),应尽快完善影像学检查进行全面评估,有助于及早明确诊断;同样需要防止低颅压综合征向颅内静脉窦血栓形成的可能性;对血栓形成的高危产妇,及时给予低分子肝素预防血栓。早诊断、多种途径联合治疗,可明显降低孕产妇死亡率和致残率。Objective Analyze the clinical characteristics,diagnosis and treatment points of stroke after cesarean section,and improve the pregnancy outcomes of pregnant women.Methods Retrospective analysis of the clinical data of 11 patients with stroke after cesarean section at the First People's Hospital of Yunnan Province from January 2016 to August 2022,to explore the causes and high-risk factors of the disease.Results Among the 11 stroke patients,5 were elderly(≥35 years old),accounting for 45.45%(5/11);there were 5 cases of gestational diabetes mellitus(GDM),accounting for 45.45%(5/11);there were 4 cases of pre pregnancy obesity(BMI≥28 kg/m2),accounting for 36.36%(4/11);three cases of in vitro fertilization and embryo transfer,accounting for 27.27%(3/11).The delivery method was cesarean section,and the anesthesia method was spinal anesthesia or combined spinal and epidural anesthesia.The initial symptoms were varying degrees of headache 1 to 5 days after surgery.Among the 11 cases,9 patients were initially considered to have low intracranial pressure headache after spinal anesthesia.After removing the pillow,lying flat,supplementing with isotonic saline,after symptomatic treatment,the symptoms did not improve until the patient developed convulsions,hemiplegia,and language disorders 3 to 8 days,then were diagnosed with stroke through imaging examination.After 6 months of onset,36.36%(4/11)of the 11 patients had poor prognosis,including 1 death and 3 cases with varying degrees of intellectual and physical activity disorders.Conclusion When a patient has a new headache after cesarean section,it is necessary to carefully observe the characteristics and accompanying symptoms of headache in combination with whether the patient has high risk factors such as pregnancy induced hypertension,pregnancy induced diabetes,old age,obesity,and the way of anesthesia,and carefully examine the consciousness,state,cranial nerves,motor system,nervous system,and other aspects.If headache caused by post-dural puncture caused by intraspin

关 键 词：剖宫产术 产褥期脑卒中 

分 类 号：R714.6[医药卫生—妇产科学]