本文選題：妊娠　切入點(diǎn)：產(chǎn)褥期　出處：《廣西醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討妊娠、產(chǎn)褥期合并顱內(nèi)靜脈系統(tǒng)血栓形成（CVST）的危險(xiǎn)因素。 方法：收集廣西醫(yī)科大學(xué)第一附屬醫(yī)院神經(jīng)內(nèi)科及婦產(chǎn)科2004年1月至2013年11月收治的妊娠、產(chǎn)褥期婦女住院資料，分為病例組（合并顱內(nèi)靜脈系統(tǒng)血栓形成者）和對(duì)照組（未合并顱內(nèi)靜脈系統(tǒng)血栓形成者）。CVST診斷標(biāo)準(zhǔn)參考美國心臟病協(xié)會(huì)/美國卒中協(xié)會(huì)提出的《腦靜脈系統(tǒng)血栓形成的診斷與管理指南》，，均經(jīng)腦靜脈系統(tǒng)影像學(xué)如MRV或DSA檢查確診。采用回顧性分析的方法，收集可能與該疾病發(fā)生有關(guān)的因素，如年齡、一般資料（如多胎妊娠、分娩方式、初/經(jīng)產(chǎn)婦、妊娠期高血壓疾病、病理妊娠等）、實(shí)驗(yàn)室檢查指標(biāo)（血常規(guī)、水電解質(zhì)代謝紊亂、凝血功能等）等各項(xiàng)臨床資料。采用SPSS19.0統(tǒng)計(jì)軟件包分析數(shù)據(jù)。計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差表示，組間比較采用采用兩獨(dú)立樣本t檢驗(yàn)；計(jì)數(shù)資料比較采用完全隨機(jī)兩樣本2檢驗(yàn)；選擇有統(tǒng)計(jì)學(xué)差異的因素進(jìn)行多因素Logistic回歸分析，入選標(biāo)準(zhǔn)為0.05。 結(jié)果：廣西醫(yī)科大學(xué)第一附屬醫(yī)院神經(jīng)內(nèi)科和婦產(chǎn)科2004年1月至2013年11月收治的妊娠、產(chǎn)褥期婦女共40693例，發(fā)現(xiàn)合并顱內(nèi)靜脈系統(tǒng)血栓形成的患者20例，患病率為49.1/10萬。發(fā)病年齡19～35歲，平均年齡為27.25±4.52；妊娠期發(fā)病5例，產(chǎn)褥期發(fā)病15例（剖宮產(chǎn)5例，順產(chǎn)10例）。臨床癥狀以頭痛為主的16例（80%），嘔吐4例（20%），視力障礙2例（10%），局灶性神經(jīng)功能缺損包括肢體運(yùn)動(dòng)/感覺障礙10例（50%），意識(shí)障礙5例（25%），癲癇發(fā)作6例（30%），精神行為異常1例（5%），發(fā)熱7例（35%）。18例患者接受低分子肝素抗凝治療，其中聯(lián)合組織型纖溶酶原激活劑（rt PA）溶栓治療1例，聯(lián)合阿加曲班治療1例，聯(lián)合阿司匹林治療1例，余2例患者給予改善循環(huán)、降顱壓等對(duì)癥支持治療。出院時(shí)有17例（85%）好轉(zhuǎn)，3例（15%）死亡。病例對(duì)照研究結(jié)果顯示病理妊娠、妊娠期高血壓疾病與妊娠、產(chǎn)褥期合并CVST有密切聯(lián)系。 結(jié)論： 1．妊娠、產(chǎn)褥期合并顱內(nèi)靜脈系統(tǒng)血栓形成（CVST）在臨床中少見，產(chǎn)前、產(chǎn)后均可發(fā)生，但以產(chǎn)褥期居多，且病死率較高。 2．病理妊娠、妊娠期高血壓疾病可能是妊娠、產(chǎn)褥期合并CVST的獨(dú)立危險(xiǎn)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 鹵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 鹵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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714;R743

【參考文獻(xiàn)】

中國期刊全文數(shù)據(jù)庫 前7條

1 王建禎;張開;鄭莉莉;杜長生;何心;;罕見原因引起的顱內(nèi)靜脈竇血栓形成臨床分析(附9例報(bào)告)[J];山東醫(yī)藥;2012年02期

2 朱蕾芳;房文峰;呂蓓;張林;毛旭強(qiáng);;妊娠、產(chǎn)褥期腦卒中38例臨床分析[J];江蘇醫(yī)藥;2011年19期

3 汪麗萍;鐘梅;裘毓雯;王志堅(jiān);尹愛蘭;劉健;王辰;;孕產(chǎn)婦顱內(nèi)靜脈竇血栓形成26例臨床分析[J];中國實(shí)用婦科與產(chǎn)科雜志;2008年11期

4 陳娟;陳玉萍;魏東寧;;歐洲神經(jīng)科學(xué)聯(lián)盟腦靜脈及靜脈竇血栓形成治療指南[J];中國卒中雜志;2007年09期

5 呂衛(wèi)琴;李曉琴;倪妍;;圍生期顱內(nèi)靜脈竇血栓形成8例臨床分析[J];中國實(shí)用醫(yī)藥;2013年15期

6 孟利軍;孟勝君;黃捷;呂秀東;王秀芬;李科信;;孕產(chǎn)婦顱內(nèi)靜脈竇血栓形成的臨床特點(diǎn)及治療變化[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2013年20期

7 藍(lán)靜;;孕產(chǎn)婦死亡原因分析及防控對(duì)策[J];中國傷殘醫(yī)學(xué);2014年01期

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