目的 探讨多学科合作手术治疗妊娠期出血性脑血管病后继续妊娠的安全性。方法 2013-01至2016-08医院妇产科收治6例妊娠期出血性脑血管病孕妇,经多学科会诊评估后手术治疗出血性脑血管病,术中选择性应用麻醉药;减少术前应用脑血管造影电离辐射的暴露剂量;手术中维持血流动力和血氧饱和度稳定,全程胎心监护,尽量避免胎盘血流灌注不足。手术方式为动脉瘤切除术1例,动静脉畸形合并动脉瘤切除术1例,动静脉畸形切除术2例,开颅血肿清除术1例,颅内血肿穿刺外引流术1例。结果 继续妊娠至36～37周足月或近足月剖宫产分娩,单活胎5例,双胎1例,新生儿体重2320～3400 g。新生儿预后良好。结论 妊娠期手术治疗出血性脑血管病,多学科协作综合治疗和管理患者,可以期待继续妊娠至近足月分娩。
Abstract
Objective To explore the safety of ongoing pregnancy after multidisciplinary management of hemorrhagic encephalopathy. Methods Six pregnant patients with hemorrhagic encephalopathy admitted to Beijing Tiantan Hospital between January 2013 and August 2016 were enrolled into this study, all of whom were diagnosed by multiple departments and treated by the Department of Neurosurgery. The postoperative obstetrics materials for ongoing pregnancy were analyzed. Consistent fetus monitoring was performed during operation. Results After 24-48 h at the ICU, the patients were transferred back to the obstetric wards and supervised in terms of their ongoing pregnancy. One case of midbrain aneurysm, one case of aneurysm with arteriovenous malformation, two cases of arteriovenous malformation, and two cases of spontaneous hemorrhagic cerebrovascular disease were treated with such approaches as aneurysmectomy, arteriovenous malformationectomy, crainiotomy, and intracranial hematoma drainage. The surgical sites included one left cerebellum, one right cerebellum, one occipital part of cerebrum, one right frontal lobe, one right posterior occipital lobe, one anterior artery and left middle cerebral artery. The size of the hematomas ranged from 3 to 5 cm, while onset gestational weeks ranged from 18 to 27 weeks. Five of the six pregnancies were singletons, and one was a twin, all of whom were full-term with birth weights ranging from 2320 to 3400 g. One fetus underwent preoperative and postoperative cerebrovascular radiation, and the total radiation dosage was 1.18 Rad. Conclusions Intraoperative anesthesia should be based on the patient’s condition. Radiation exposure should be limited. Hemodynamic stabilization and blood oxygen saturation should be maintained during operation. Postoperative multidisciplinary evaluation and treatment are needed so that the patient can continue pregnancy to full term.
关键词
妊娠期出血性脑血管病 /
手术治疗 /
妊娠
Key words
gestational hemorrhagic encephalopathy /
surgical treatment /
ongoing pregnancy
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