妊娠、产褥期合并颅内静脉系统血栓形成的危险因素分析

发布时间：2018-03-02 18:12

  本文选题：妊娠　切入点：产褥期　出处：《广西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨妊娠、产褥期合并颅内静脉系统血栓形成（CVST）的危险因素。 方法：收集广西医科大学第一附属医院神经内科及妇产科2004年1月至2013年11月收治的妊娠、产褥期妇女住院资料，分为病例组（合并颅内静脉系统血栓形成者）和对照组（未合并颅内静脉系统血栓形成者）。CVST诊断标准参考美国心脏病协会/美国卒中协会提出的《脑静脉系统血栓形成的诊断与管理指南》，，均经脑静脉系统影像学如MRV或DSA检查确诊。采用回顾性分析的方法，收集可能与该疾病发生有关的因素，如年龄、一般资料（如多胎妊娠、分娩方式、初/经产妇、妊娠期高血压疾病、病理妊娠等）、实验室检查指标（血常规、水电解质代谢紊乱、凝血功能等）等各项临床资料。采用SPSS19.0统计软件包分析数据。计量资料采用均数±标准差表示，组间比较采用采用两独立样本t检验；计数资料比较采用完全随机两样本2检验；选择有统计学差异的因素进行多因素Logistic回归分析，入选标准为0.05。 结果：广西医科大学第一附属医院神经内科和妇产科2004年1月至2013年11月收治的妊娠、产褥期妇女共40693例，发现合并颅内静脉系统血栓形成的患者20例，患病率为49.1/10万。发病年龄19～35岁，平均年龄为27.25±4.52；妊娠期发病5例，产褥期发病15例（剖宫产5例，顺产10例）。临床症状以头痛为主的16例（80%），呕吐4例（20%），视力障碍2例（10%），局灶性神经功能缺损包括肢体运动/感觉障碍10例（50%），意识障碍5例（25%），癫痫发作6例（30%），精神行为异常1例（5%），发热7例（35%）。18例患者接受低分子肝素抗凝治疗，其中联合组织型纤溶酶原激活剂（rt PA）溶栓治疗1例，联合阿加曲班治疗1例，联合阿司匹林治疗1例，余2例患者给予改善循环、降颅压等对症支持治疗。出院时有17例（85%）好转，3例（15%）死亡。病例对照研究结果显示病理妊娠、妊娠期高血压疾病与妊娠、产褥期合并CVST有密切联系。 结论： 1．妊娠、产褥期合并颅内静脉系统血栓形成（CVST）在临床中少见，产前、产后均可发生，但以产褥期居多，且病死率较高。 2．病理妊娠、妊娠期高血压疾病可能是妊娠、产褥期合并CVST的独立危险因素。
[Abstract]:Objective: to investigate the risk factors of intracranial venous thrombosis during pregnancy and puerperium. Methods: the clinical data of pregnant and puerperal women admitted to the Department of Neurology and Obstetrics and Gynecology in the first affiliated Hospital of Guangxi Medical University from January 2004 to November 2013 were collected. Divided into case group (with intracranial venous thrombosis) and control group (without intracranial venous thrombosis). CVST diagnostic criteria refer to the American Heart Association / American Stroke Association proposed by the "Cerebral Venous system Blood" Guidelines for the diagnosis and Management of Thrombus formation. The diagnosis was confirmed by imaging of the cerebral venous system such as MRV or DSA. Collect factors that may be relevant to the development of the disease, such as age, general data (e.g. multiple pregnancy, mode of delivery, primary / menstrual pregnancy, hypertensive disorder complicating pregnancy, pathological pregnancy, etc.), laboratory examination indicators (blood routine, etc.). SPSS19.0 statistical software package was used to analyze the data. The measurement data were expressed as mean 卤standard deviation, and two independent samples t test were used for the comparison between groups. The count data were compared by two complete random sample 2 tests, and the factors with statistical difference were selected for multivariate Logistic regression analysis. The inclusion standard was 0.05. Results: from January 2004 to November 2013, 40693 pregnant women were admitted to the Department of Neurology and Obstetrics and Gynecology, the first affiliated Hospital of Guangxi Medical University. 20 patients with intracranial venous thrombosis were found. The prevalence rate was 49.1 / 100,000. The age of onset was 1935 years old with an average age of 27.25 卤4.52.The incidence of pregnancy and puerperium were 5 cases and 15 cases (5 cases of cesarean section, 5 cases of cesarean section, 5 cases of gestation and 15 cases of puerperium respectively). The clinical symptoms were mainly headache in 16 cases, vomiting in 4 cases, vision disturbance in 2 cases, focal nerve function defect in 10 cases, including 10 cases of limb motor / sensory dysfunction, 5 cases of disturbance of consciousness, 6 cases of epileptic seizure, 30 cases of epilepsy, and mental function. In order to make one case abnormal, 7 cases with fever were treated with low molecular weight heparin anticoagulant therapy, 18 cases with fever were treated with low molecular weight heparin (LMWH) anticoagulant therapy. Among them, one case was treated with thrombolytic therapy with tissue plasminogen activator (PTPA), one case was treated with agatoban, one case was treated with aspirin, and the other 2 cases were treated with improved circulation. There were 17 cases (85%) improved and 3 cases died. Case control study showed that pathological pregnancy, hypertensive disorder complicating pregnancy and pregnancy and puerperium complicated with CVST were closely related. Conclusion:. 1. In pregnancy, puerperium complicated with intracranial venous thrombosis (CVST) is rare in clinic. It can occur before and after delivery, but the puerperium is more common and the mortality is higher. 2. Pathological pregnancy, hypertensive disorder complicating pregnancy may be an independent risk factor for pregnancy and puerperium complicated with CVST.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714;R743

【参考文献】

中国期刊全文数据库 前7条

1 王建祯;张开;郑莉莉;杜长生;何心;;罕见原因引起的颅内静脉窦血栓形成临床分析(附9例报告)[J];山东医药;2012年02期

2 朱蕾芳;房文峰;吕蓓;张林;毛旭强;;妊娠、产褥期脑卒中38例临床分析[J];江苏医药;2011年19期

3 汪丽萍;钟梅;裘毓雯;王志坚;尹爱兰;刘健;王辰;;孕产妇颅内静脉窦血栓形成26例临床分析[J];中国实用妇科与产科杂志;2008年11期

4 陈娟;陈玉萍;魏东宁;;欧洲神经科学联盟脑静脉及静脉窦血栓形成治疗指南[J];中国卒中杂志;2007年09期

5 吕卫琴;李晓琴;倪妍;;围生期颅内静脉窦血栓形成8例临床分析[J];中国实用医药;2013年15期

6 孟利军;孟胜君;黄捷;吕秀东;王秀芬;李科信;;孕产妇颅内静脉窦血栓形成的临床特点及治疗变化[J];现代中西医结合杂志;2013年20期

7 蓝静;;孕产妇死亡原因分析及防控对策[J];中国伤残医学;2014年01期

本文编号：1557619