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目的探讨妊娠和产褥期蛛网膜下腔出血(SAH)的病因、发病时间、临床特点及预后。方法回顾性分析1995年9月至2009年9月我院收治的11例妊娠和产褥期SAH患者的临床资料。结果本组11例中,初产妇6例,产前9例,孕13～36周,平均孕周(26.11±8.57)周,中期妊娠4例,晚期妊娠5例,产后2例。脑动静脉畸形(AVM)3例,动脉瘤2例,AVM合并动脉瘤1例,子痫2例,静脉窦血栓1例,病因不明确2例。手术治疗3例,γ刀1例,孕妇预后均良好,其中胎儿引产1例;保守治疗7例,其中孕妇死亡4例,胎儿死亡3例。结论 SAH是妊娠和产褥期少见而严重的并发症,多见于晚期妊娠,以动脉瘤和AVM最常见。治疗应以神经外科原则为基础,Hunt-Hess分级低于IV级时应及时神经外科干预。外科干预的时机和分娩方式应根据不同孕周而不同。
Objective To investigate the causes, onset, clinical features and prognosis of subarachnoid hemorrhage (SAH) during pregnancy and puerperium. Methods The clinical data of 11 patients with SAH during pregnancy and puerperium from September 1995 to September 2009 in our hospital were retrospectively analyzed. Results Among the 11 cases, 6 cases were primipara, 9 cases were prenatal and 13 to 36 weeks old. The average gestational age was (26.11 ± 8.57) weeks. There were 4 cases of interim pregnancy, 5 cases of late pregnancy and 2 cases of postpartum. 3 cases of cerebral arteriovenous malformation (AVM), 2 cases of aneurysm, 1 case of AVM with aneurysm, 2 cases of eclampsia and 1 case of venous sinus thrombosis. The etiology was not clear in 2 cases. Surgical treatment in 3 cases, γ knife in 1 case, the prognosis of pregnant women were good, of which fetus induced labor in 1 case; conservative treatment in 7 cases, including pregnant women in 4 cases, 3 cases of fetal death. Conclusions SAH is a rare and serious complication of pregnancy and puerperium, which is more common in advanced pregnancy, with aneurysms and AVMs being the most common. Treatment should be based on the principles of neurosurgery, Hunt-Hess grading below the level of IV should be timely neurosurgical intervention. The timing of surgical intervention and mode of delivery should be different according to different gestational age.