Martin James N, Thigpen Brad D, Moore Robert C, Rose Carl H, Cushman Julie, May Warren
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216-4505, USA.
Obstet Gynecol. 2005 Feb;105(2):246-54. doi: 10.1097/01.AOG.0000151116.84113.56.
To identify important clinical correlates of stroke in patients with preeclampsia and eclampsia.
The case histories of 28 patients who sustained a stroke in association with severe preeclampsia and eclampsia were scrutinized with particular attention to blood pressures.
Stroke occurred antepartum in 12 patients, postpartum in 16. Stroke was classified as hemorrhagic-arterial in 25 of 27 patients (92.6%) and thrombotic-arterial in 2 others. Multiple sites were involved in 37% without distinct pattern. In the 24 patients being treated immediately before stroke, systolic pressure was 160 mm Hg or greater in 23 (95.8%) and more than 155 mm Hg in 100%. In contrast, only 3 of 24 patients (12.5%) exhibited prestroke diastolic pressures of 110 mm Hg or greater, only 5 of 28 reached 105 mm Hg, and only 6 (25%) exceeded a mean arterial pressure of 130 mm Hg before stroke. Only 3 patients received prestroke antihypertensives. Twelve patients sustained a stroke while receiving magnesium sulfate infusion; 8 had eclampsia. Although all blood pressure means after stroke were significantly higher than prestroke, only 5 patients exhibited more than 110 mm Hg diastolic pressures. In 18 of 28 patients, hemolysis, elevated liver enzymes, low platelets syndrome did not significantly alter blood pressures compared with non-hemolysis, elevated liver enzymes, low platelets. Mean systolic and diastolic changes from pregnancy baseline to prestroke values were 64.4 and 30.6 mm Hg, respectively. Maternal mortality was 53.6%; only 3 patients escaped permanent significant morbidity.
In contrast to severe systolic hypertension, severe diastolic hypertension does not develop before stroke in most patients with severe preeclampsia and eclampsia. A paradigm shift is needed toward considering antihypertensive therapy for severely preeclamptic and eclamptic patients when systolic blood pressure reaches or exceeds 155-160 mm Hg.
III.
确定先兆子痫和子痫患者中风的重要临床相关因素。
仔细研究了28例与重度先兆子痫和子痫相关的中风患者的病史，特别关注血压情况。
12例患者在产前发生中风，16例在产后发生中风。27例患者中有25例（92.6%）中风类型为出血性动脉型，另外2例为血栓性动脉型。37%的患者有多个部位受累，无明显规律。在中风前正在接受治疗的24例患者中，23例（95.8%）收缩压为160 mmHg或更高，100%的患者收缩压超过155 mmHg。相比之下，24例患者中只有3例（12.5%）中风前舒张压为110 mmHg或更高，28例中只有5例达到105 mmHg，只有6例（25%）中风前平均动脉压超过130 mmHg。只有3例患者在中风前接受了降压治疗。12例患者在接受硫酸镁输注时发生中风；8例患有子痫。虽然中风后所有血压平均值均显著高于中风前，但只有5例患者舒张压超过110 mmHg。28例患者中有18例，与非溶血、肝酶升高、血小板减少综合征相比，溶血、肝酶升高、血小板减少综合征并未显著改变血压。从妊娠基线到中风前值，收缩压和舒张压的平均变化分别为64.4 mmHg和30.6 mmHg。孕产妇死亡率为53.6%；只有3例患者未留下永久性严重后遗症。
与重度收缩期高血压相反，大多数重度先兆子痫和子痫患者在中风前不会出现重度舒张期高血压。当收缩压达到或超过155 - 160 mmHg时，对于重度先兆子痫和子痫患者，需要转变观念，考虑进行降压治疗。
III级
