孕产妇早期深静脉血栓形成13例诊治分析

发布时间：2018-05-14 07:32

本文选题：孕产妇 + 深静脉血栓形成　；参考：《中国妇产科临床杂志》2015年01期

【摘要】：目的探讨合并深静脉血栓形成孕产妇的临床诊治过程与母儿结局。方法回顾性分析首都医科大学附属北京妇产医院2004年11月至2013年9月间妊娠期及产褥期深静脉血栓形成孕产妇的临床资料。结果依据临床表现及进一步的影像学检查,共有13例孕产妇符合深静脉血栓形成的诊断,其中下肢深静脉血栓形成12例,肺栓塞1例同时合并右下肢静脉血栓形成,69.2%的患者存在除血液高凝外的其他导致深静脉血栓形成的病史与高危因素。血液化验纤维蛋白原定量(4.82±0.87)g/L,D-dimer定量(659.00±142)ng/ml,均超出参考值范围,符合孕产妇高凝状态及继发纤溶亢进,所有的患者均进行了抗凝治疗,对肺栓塞患者采取了手术取栓治疗,无出血并发症,所有患者正常生存。2例为孕期发生深静脉血栓,孕周分别为25周双胎和38周单胎妊娠;双胎孕25周患者行米索前列醇引产术,孕38周单胎妊娠者行剖宫产终止妊娠。11例为产褥期发生,行抗凝治疗后未观察到产后出血(500ml/d)。所有患者中7例剖宫产终止妊娠,新生儿正常生存,6例阴道分娩,其中4例足月儿生存,2例行米索前列醇引产胎儿丢失。结论妊娠期及产褥期血液处于高凝状态,存在诱发因素时深静脉血栓形成的风险明显增加,对于确诊深静脉血栓形成的孕产妇,抗凝治疗是有效的措施;对于严重影响血流动力学稳定的肺栓塞患者,手术取栓结局良好。
[Abstract]:Objective to investigate the clinical diagnosis and treatment process and maternal and fetal outcome of pregnant women with deep venous thrombosis (DVT). Methods the clinical data of pregnant women with deep venous thrombosis during pregnancy and puerperium from November 2004 to September 2013 in Beijing Maternity Hospital affiliated to Capital Medical University were analyzed retrospectively. Results according to clinical manifestation and further imaging examination, 13 cases of pregnant and parturient women were diagnosed with deep venous thrombosis, including 12 cases of deep vein thrombosis of lower extremity. 69.2% of the patients with pulmonary embolism associated with venous thrombosis of the right lower extremity had history and high risk factors of deep venous thrombosis except hypercoagulability. In blood tests, fibrinogen quantification was 4.82 卤0.87 g / L D-dimer, 659.00 卤142ng / ml, which exceeded the reference range, and was in accordance with maternal hyperfibrinolysis and hyperfibrinolysis. All the patients were treated with anticoagulant therapy, and the patients with pulmonary embolism were treated with surgical thrombus extraction. There were no complications of hemorrhage. The normal survival rate of all patients was deep venous thrombosis during pregnancy. The gestational weeks were 25 weeks twin pregnancy and 38 weeks single pregnancy, while misoprostol induced labor was performed in 25 weeks of twin pregnancy. The termination of pregnancy by cesarean section at 38 weeks of gestation occurred in 11 cases of puerperium. No postpartum hemorrhage was observed after anticoagulant therapy. Among all the patients, 7 cases were aborted by cesarean section, 6 cases were vaginal delivery, and 2 cases were misoprostol induced fetal loss. Conclusion the blood in pregnancy and puerperium is in hypercoagulable state, and the risk of deep venous thrombosis is obviously increased when there are inducing factors. Anticoagulant therapy is an effective measure for pregnant women who are diagnosed with deep venous thrombosis. In patients with pulmonary embolism which seriously affected hemodynamic stability, the outcome of thrombus removal was good.
【作者单位】：首都医科大学附属北京妇产医院产科;中国医学科学院北京协和医院心血管外科;
【分类号】：R714.252

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