妊娠合并可逆性后部脑病综合征6例临床分析

发布时间：2018-05-11 02:43

本文选题：可逆性后部脑病综合征 + 妊娠　；参考：《实用妇产科杂志》2015年08期

【摘要】：目的:探讨妊娠合并可逆性后部脑病综合征(PRES)的临床及影像学特点、治疗及预后,提高诊疗水平。方法:回顾性分析6例妊娠合并PRES患者的临床资料,分析其临床表现、影像学特点、治疗过程及预后。结果:6例患者中有5例子痫或子痫前期(其中4例发生于产前,1例发生于产后),1例为地诺前列酮(普贝生)引产时发生子痫。均为急性起病,临床表现主要为突发头痛、抽搐、视觉障碍、意识障碍等。颅脑CT或MRI提示大脑后部双侧对称、多灶性分布,累及顶枕叶为主的皮质、皮质下病灶。CT病灶呈低密度,典型的MRI检查T1WI呈低信号,T2WI及FLAIR高信号。所有患者发病后均给于硫酸镁冲击量加维持量解痉;4例静脉泵入亚宁定(盐酸乌拉地尔注射液)或佩尔地平降压,2例口服降压药;所有患者均给予甘露醇或甘油果糖静脉滴注降颅压治疗,其他治疗还有纠正酸碱平衡紊乱、对症支持等治疗。所有患者经积极治疗,均未遗留后遗症,发病到治愈出院时间7~11天。结论:妊娠合并PRES常见于子痫及子痫前期患者,颅脑MRI是诊断本病的重要检查手段。对该病应提高认识,及早发现及时治疗,病情可逆转,预后良好。
[Abstract]:Objective: to investigate the clinical and imaging features, treatment and prognosis of pregnancy with reversible posterior encephalopathy syndrome (Pres), and to improve the diagnosis and treatment level. Methods: the clinical data, clinical manifestations, imaging features, treatment process and prognosis of 6 cases of pregnancy complicated with PRES were analyzed retrospectively. Results there were 5 cases of eclampsia or preeclampsia in 6 cases (4 cases occurred before and 1 case occurred in postpartum and 1 case was induced by prostaglandone). The clinical manifestations were sudden headache, convulsion, visual disturbance, consciousness disorder and so on. Craniocerebral CT or MRI showed bilateral symmetry, multi-focal distribution, mainly parietal occipital cortex, hypodensity of subcortical focus. Typical MRI showed low signal intensity on T _ 2WI and FLAIR. All the patients were treated with magnesium sulfate shock volume plus maintenance volume, 4 cases received intravenous injection of anindine (urapidil hydrochloride injection) or 2 cases of perdipine antihypertensive drug. All patients were treated with mannitol or fructose intravenous drip to reduce intracranial pressure. After active treatment, all patients had no sequelae and the time from onset to cure was 711 days. Conclusion: pregnancy with PRES is common in patients with eclampsia and preeclampsia. Craniocerebral MRI is an important diagnostic method for this disease. Understanding of the disease should be improved, early detection and timely treatment, the disease can be reversed, the prognosis is good.
【作者单位】：北京大学人民医院;
【分类号】：R714.25;R742

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