The Prognosis of Stroke During Pregnancy

懷孕期間發生腦中風之預後

蔡宗宏(Tzong-Horng Tasy) ； 梁秋萍(Chau-Peng Leong) ； 劉耀宗(Yiu-Chung Lau) ； 劉嘉為(Chia-Wei Liou) ； 許德耀(Te-Yao Hsu)

《中華民國復健醫學會雜誌》 30卷3期 (2002/09) Pp. 131-140

摘要

臨床上，因懷孕期間發生腦中風的病例不多，也一直沒有明確的統計以顯示其預後如何。本篇主要以年輕的女性中風病人為對照組(stroke-of-young-female group, SYF)，收集從1991年至1999年間，在高雄天主教聖功醫院和高雄長庚醫院求診病例中，探討懷孕期間發生腦中風的病患(stroke-during-pregnancy group, SDP )，其發生率、死亡率、流行病學、致病因素、危險因子、嚴重度與預後為何；並分析懷孕是否為腦中風的致病因子。同時也探討所生嬰兒是否有不良的影響。
在這8年期間，共收集31175位懷孕婦女，其中11位發生腦中風(SDP，發生率0.035%)。同時，在32558位腦中風病人中，共有349位是屬於年輕女性(小於45歲) (SYF，發生率1.1%)。二組均有高死亡率(約18%)。與 SYF 組比較，SDP組在腦中風起始症狀中，有較高比率的意識變化(64% vs 28%)和抽痙表現(55% vs 6%)，但在其他方面，則二組無明顯差異。此外，SDP組所生嬰兒比一般台灣地區新生兒有較高的死亡率(9% vs 0.67%)和較低出生體重(2.5 vs 3.4kg)。
雖然腦中風在這二組均造成高死亡率和罹病率，但“懷孕”這個因子在許多方面，並不會造成更嚴重的後果。在年輕的女性腦中風病患中，不論是否懷孕，均有相似的預後和功能恢復。

關鍵字

腦中風 ； 懷孕 ； 年輕女性

並列摘要

Background: This study focused on the differences in incidence, mortality, epidemiology, causes, risk factors, severity, and prognosis between two groups of patients; a stroke-during-pregnancy (SDP) group and a stroke-of-young-female (SYF) group with similar physical status. We investigated whether pregnancy was a contributing factor to stroke, and reviewed the maternal characteristics and fetal outcome for patients suffering from stroke during pregnancy.
Methods: Based on a restrospective analysis of stroke occurring during pregnancy and in young female patients during the 8-year period from January 1991 to February 1999 at Kaohsiung ST. Joseph Hospital and Chang-Gung Hospital. In both groups, all patients underwent diagnostic procedures, including history taking, neurological examination, extensive laboratory testing, and neuroimaging studies. Also included were the obstetric histories and complications of the SDP group.
Results: During this 8-year period, there were 11 stroke patients among 31175 pregnant women, yielding an incidence of about 0.035 % in the SDP group. At the same time, there were 32558 stroke patients, including 349 young women, with an incidence of 1.1 % in the SYF group. Both groups had high mortality rates (about 18 %). Compared with the SYF group, the SDP group was younger (28.5 vs 34.0 years, P ＜ 0.001), and had higher rates of consciousness changes (64% vs 28%) and seizures (55% vs 6%) as initial stroke symptoms. However, there were no significant differences in other aspects, such as mortality rate, type of stroke, motor impairment and recovery, complication rate and average number of admission days. Moreover, the babies of the SDP group had a higher mortality rate (9% vs 0.67%) and lower birth weight (2.5 vs 3.4 kg) than Taiwanese newborns in general. This combined with low Apgar scores and low maternal coma scale scores among the patients having emergent cesarean deliveries.
Conclusions: Although stroke in both groups caused high mortality and morbidity, the pregnancy factor did not cause increased severity in a majority of aspects. There were similar prognoses among SYF patients for neurological sequelae and functional status in this study, whether the patient was pregnant or not.

並列關鍵字

stroke ； pregnancy ； young female