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題名 | Stroke Complicating Pregnancy and the Puerperium=併發於妊娠期及產褥期之中風 |
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作者 | 王國楨; 陳治平; 楊育正; 王國恭; 洪芳宜; 蘇聰賢; Wang, Kuo-chen; Chen, Chie-pein; Yang, Yuh-cheng; Wang, Kuo-gon; Hung, Fang-yi; Su, Tsung-hsein; |
期刊 | 中華醫學雜誌 |
出版日期 | 19990100 |
卷期 | 62:1 1999.01[民88.01] |
頁次 | 頁13-19 |
分類號 | 417.346 |
語文 | eng |
關鍵詞 | 懷孕; 產褥期; 中風; Pregnancy; Puerperium; Stroke; |
中文摘要 | 背景 由於現代醫學的進步和孕產婦獲得完善的照顧,婦女因產科原因死亡的機 率大大減少,因而非產科的原因則顯得格外重要。併發於妊娠期及產褥期的中風,會給婦女 帶來高的死亡率及不良預後。本文探討併發於妊娠期及產褥期之中風的發生率、病因及必要 的治療原則。 方法 我們蒐集1986年至1996年的10年間,於懷孕期間或產後6週內罹患中風的病 人。中風的定義為:急性突發的神經異常症候群,包括出血性或缺血性腦部血管病變。所有 的病人都用電腦斷層掃描或核磁共振光譜儀來確定診斷。病人的病歷皆由資深的婦產科醫生 和神經科醫生確認和校閱。 結果 共有13位病人在妊娠期或產褥期罹患中風,其中9位屬於出血性,4位屬於缺 血性。同一時期內,馬偕紀念醫院共有85,321位生產數,所以中風的發生率約為1/6,500。 在9位出血性中風病人中,3位有先兆子�o,1位有妊娠糖尿病。共有5位中風病人死亡, 死亡率為38%;在存活的病人中,有5位殘留神經異常症狀,佔63%;而高達46%的病人 是在產後發生中風的。 結論 併發於妊娠期及產褥期的中風,常造成高死亡率及不良預後。早期預防、正確的 診斷及適當治療,均可減少此併發症。因此,圍產期的婦女應當獲得完善的照顧。 |
英文摘要 | Background. The role of nonobstetric factors, such as stroke, in maternal mortality has become of increasing importance because maternal deaths resulting directly from obstetric causes are decreasing. Strokes contribute to high mortality and morbidity, and are severe complications during pregnancy and puerperium. The objective of this study was to investigate the maternal outcome of patients with complications of stroke during pregnancy and puerperium. The causes, incidence and essential management of stroke are also reviewed. Methods. During the 10-year period from January, 1986, to January, 1996, women who suffered from stroke during pregnancy, or up to six weeks postpartum, and were discharged from our hospital were identified. Stroke was defined as the abrupt onset of a focal neurologic syndrome that consisted of hemorrhagic and ischemic central nervous system events. All were assessed using computerized tomography or magnetic resonance imaging. Neurologists reviewed each case from the medical records. Results. Thirteen women who had had a stroke during pregnancy or puerperium were identified. Nine of these women had intracerebral hemorrhage and four had ischemic strokes. During this 10- year period, approximately 85,321 women gave birth at the Mackay Memorial Hospital, and the incidence of stroke was approximately 1 in 6,500 pregnancies. Among the nine case of hemorrhagic strokes, three women had preeclampsia and one had gestational diabetes mellitus. Mortality from strokes was 38%, and 63% of survivors had residual neurologic deficits; 46% of the strokes occurred during the puerperium. Conclusions. Stroke during pregnancy and puerperium causes high mortality and morbidity. Early diagnosis and adequate treatment cannot be overemphasized, as prompt and proper management is benificial for outcome. The same meticulous care provided during the antepartum and intrapartum periods should be continued into the puerperium. |
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