探讨围产期脑卒中患者影响诊治及预后的相关因素。

回顾分析2011年2月至2016年3月入住暨南大学附属第一医院妇产科的19例围产期脑卒中患者的临床资料，对发病相关因素、诊断路径、治疗方法及母儿预后等进行分析。

(1)5年间共收住36 370例孕产妇，19例发生围产期脑卒中，围产期脑卒中发病率为52.2/10万次分娩。其中出血性脑卒中14例，缺血性脑卒中5例。(2)14例出血性脑卒患者主要发生在孕晚期，首发症状中13例为头痛、10例为恶心呕吐。10例入院时伴有意识不清。影响孕妇预后的主要因素是：出血量、出血部位、治疗方式、就诊时意识状态及发病到就诊时间。脑出血量<15 ml者保守治疗效果好。发病到就诊时间≤6 h者5例，其中4例治疗后无后遗症；>6 h者9例，其中1例死亡、1例植物人、5例遗留后遗症。胎儿预后与发病孕周、家庭意愿以及发病后是否能及时诊断立即救治胎儿相关。(3)5例缺血性脑卒中患者均为脑静脉血栓栓塞，发病时间主要在孕早期和产褥期，多以单侧肢体活动障碍为首发症状，孕产妇预后主要与梗塞范围及治疗有关，胎儿预后与发病孕周、家庭意愿有关。

出血性脑卒中以头痛、恶心呕吐为主要临床表现，缺血性脑卒中以肢体运动障碍为主要临床表现；出血性脑卒中患者发病到就诊时间≤6 h者母儿预后较好。

To investigate the related factors of diagnosis, treatment and prognosis of perinatal stroke patients.

A retrospective study was conducted in the clinical data of 19 pregnant patients with perinatal stroke in The First Affiliated Hospital of Jinan University from February 2011 to March 2016. We analyzed the relevant factors on the pathogenesis, clinical diagnosis, treatment path, prognosis of mother and fetus.

(1) During 5 years, 36 370 pregnancies were admitted, and there were 19 patients with perinatal stroke. The incidence of perinatal stroke was 52.2/100 000. Fourteen were hemorrhagic stroke, 5 were ischemic stroke. (2) Fourteen hemorrhagic stroke patients were mainly occurred in late pregnancy. Most of their first symptoms were headache (13 cases) and nausea and vomiting (10 cases). Ten cases were unconscious on admission. Maternal prognoses were mainly relevant to the amount of bleeding, hemorrhage location, treatment method, and state of consciousness on admission and the time from symptom onset to visit. The patient with cerebral bleeding less than 15 ml recovered well after conservative treatment. Five cases with onset-to-visit interval time less than 6 hours, 4 of them had no sequelae after treatment. However, 9 cases whose onset-to-visit interval time more than 6 hours, 1 patient died, 1 patient developed into persistent vegetative state, and 5 patients had sequela. The prognoses of fetuses were relevant to the gestational age of onset, the family desire and the time interval from diagnosis to fetal treatment. (3) Five ischemic stroke patients were all cerebral veins thrombosis, mainly occurred in the first trimester of pregnancy and puerperium. Limb movement disorder was the first symptom. Maternal prognoses were mainly relevant to treatment and infarction area. The prognoses of their fetus were relevant to the onset gestational age and the family desire.

Headache, nausea and vomiting were the main clinical manifestation of hemorrhagic stroke in pregnancy, and physical movement disorder was the main clinical manifestation of ischemic stroke in pregnancy. Hemorrhagic stroke patients with onset-to-visit interval time less than 6 hours had better pregnancy outcomes.