国际麻醉学与复苏杂志   2018, Issue (8): 8-8
    
妊娠合并颅内占位性病变的临床分析和麻醉处理
董佳, 彭宇明, 冉强强, 李艳, 朱晓东, 韩如泉1()
1.首都医科大学附属北京天坛医院
Clinical characteristics and anesthesia management of intracranial space-occupying lesions during pregnancy: a retrospective analysis
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摘要:

目的 分析妊娠合并颅内占位患者的临床特点,总结麻醉管理经验。 方法 回顾性分析妊娠合并颅内占位患者34例临床资料、治疗、麻醉管理及治疗转归。 结果 妊娠合并颅内占位患者共34例,其中垂体瘤3例,神经鞘瘤2例,血管母细胞瘤5例,海绵状血管瘤5例,动脉瘤1例,皮样囊肿1例,脑膜瘤2例,混合性胶质神经元肿瘤1例,胶质瘤12例,髓母细胞瘤1例,绒癌1例。孕早期7例,孕中期13例,孕晚期14例。其中急诊入院28例。神经外科处理:先行神经外科手术治疗9例,同期神经外科治疗及剖宫产手术3例,先行剖宫产手术后期神经外科手术治疗12例,保守治疗7例,剖宫产后放弃治疗3例。神经外科手术方式中占位切除19例,血肿清除或去骨片减压3例,介入栓塞1例,脑室腹腔分流1例。产科处理包括:立即终止妊娠27例(同期神经外科手术3例),期待妊娠7例。孕中晚期26例患者行剖宫产,硬膜外麻醉16例,全身麻醉10例;入院时患者警觉/镇静评分(Observer′s Assessment of Alertness/Sedation, OAA/S)全身麻醉组明显低于椎管内麻醉组(P<0.05),胎儿娩出后椎管内麻醉组MAP明显降低(P<0.05)。产妇死亡4例,胎儿死亡2例。 结论 妊娠合并颅内占位性病变危及母胎安全。产科及神经外科手术的时序及麻醉选择至关重要,需多科室协作权衡利弊,结合患者病情、颅内压以及胎龄等因素进行综合判断。

关键词: 妊娠; 颅内占位; 麻醉; 神经外科
Abstract:

Objective To analyze and summarize the clinical features and anesthesia management of patients with intracranial mass lesion during pregnancy. Methods We retrospectively collected 34 cases of intracranial mass lesions during pregnancy in our hospital from 2010 to 2017, and analyzed the characteristics, treatment, choice of anesthesia, and outcomes of the patients. Results A total of 34 cases of pregnant women suffered from intracranial mass lesions were enrolled in this study, and include 3 cases of pituitary adenoma, 2 cases of schwannoma, 5 cases of hemangioblastoma, 5 cases of hemangioma, 1 case of aneurysm, 1 case of dermoid cyst, 2 cases of meningioma, 1 case of neuroglial and neuronal mixed tumor, 12 cases of glioma, 1 case of medulloblastoma, and 1 case of choriocarcinoma. Regarding pregnant stages, 7 cases were in the early trimester, 13 cases in middle trimester, and 14 cases in late trimester of pregnancy. Twenty eight out of 34 cases were admitted into the hospital as emergency. As for the treatment, 9 cases received emergency neurosurgery, 3 cases received caesarean section and neurosurgery, 12 cases received emergency neurosurgery after caesarean section, 7 cases received conservative treatment, and 3 cases withdrew treatment after caesarean section. In neurosurgery treatment, 19 cases received brain mass lesion resection, 3 cases received hematoma clearance or decompression, 2 cases respectively received ventricular-peritoneal shunt and endovascular treatment. For obstetric management, 27 cases terminated pregnancy and 7 cases were expected to delivery. Twenty six out of 27 cases in the middle and late trimester of pregancy underwent caesarean section, and among them, 16 and 10 cases respectively received epidural and general anesthesia. The Observer′s Assessment of Alertness/Sedation(OAA/S) in patients received general anesthesia was lower than those received epidural anesthesia (P<0.05). MAP decreased more rapidly after delivery in patients under epidural anesthesia during surgery. There were 4 cases of maternal death and 2 cases of fetal death. Conclusions Intracranial mass lesion during pregnancy increased the risk of maternal and fetal death. The appropriate treatment requires comprehensive diagnosis involving obstetrician, anesthesiologists and neurosurgeons to fully evaluate patient′s intracranial tumor, gestational age and fetal maturity to timely terminate pregnancy and carry out appropriate neurosurgical treatment to ensure the safety of mother and fetus.

Key words: Pregnancy; Intracranial mass lesion; Anesthesia; Neurosurgery