一位30歲孕婦於生產時以意識改變為表現

A 30-Year-Old Pregnant Woman Presented With Altered Consciousness During Vaginal Delivery

懷孕婦女併發腦血管意外是罕見的產科急症，其中重要的危險因素是子癲前症。本文案例是一位 30 歲初次懷孕39週又3天婦女，無特殊疾病史， 入院待產時出現高血壓合併蛋白尿，被診斷為子癲前症，於自然生產時發生嗜睡及意識改變。醫療團隊藉由神經學檢查及電腦斷層掃描診斷為腦梗塞，立即給予血栓溶解劑治療。治療中密切監測覺察病人有新的神經學異常，立即再度執行電腦斷層掃描，發現後續發生的右側大腦出血，緊急行顱骨切開手術清除血塊。術後病人仍有明顯的左側偏癱，經過積極的復健治療，出院時左上肢肌力3分，左下肢肌力4分，可使用拐杖步行移動。對於子癲前症的高危險妊娠，從待產、生產以至產後過程，均應密切監測血壓及神經學變化，如併發嗜睡及意識改變時，應快速及正確做相關腦血管疾病的鑑別診斷，早期診斷發現，預防惡化再發生，期能在中風黃金時間三小時內及早治療，降低病人殘障、失能及死亡的機率。

 

Stroke is an uncommon but serious potential complication of pregnancy. A 30-year-old woman was in her 39+3 weeks of first pregnancy without any past medical history . After admission, she was diag­nosed as preeclampsia due to hypertension with p1roteinuria. Drowsiness and changes of conscious­ness occurred during delivery. The neurological examination and brain CT scan revealed cerebral infarction and thrombolysis was performed. During the treatment new neurological abnormalities was found, CT scan was immediately performed again. Right cerebral hemorrhage was confirmed and an emergency craniotomy was performed. After the operation, the patient still suffered from obvious left hemiplegia. After active rehabilitation treatment, the muscle strength of the left upper limb was 3 points and the muscle strength of the left lower limb was 4 points at the time of discharge, and she could walk with crutches. For high-risk pregnancy with preeclampsia, blood pressure and neurological changes should be closely monitored during labor, delivery, and postpartum. If symptoms as drowsi­ness and changes in consciousness are shown, the differential diagnosis of related cerebrovascular dis­eases should be made quickly and correctly. To prevent the recurrence of deterioration, early treatment is expected within three hours of the prime time of stroke. The probability of handicapped, disability and death of patients can be reduced.