本文選題：孕產(chǎn)婦 + 深靜脈血栓形成��； 參考：《中國婦產(chǎn)科臨床雜志》2015年01期

【摘要】：目的探討合并深靜脈血栓形成孕產(chǎn)婦的臨床診治過程與母兒結(jié)局。方法回顧性分析首都醫(yī)科大學(xué)附屬北京婦產(chǎn)醫(yī)院2004年11月至2013年9月間妊娠期及產(chǎn)褥期深靜脈血栓形成孕產(chǎn)婦的臨床資料。結(jié)果依據(jù)臨床表現(xiàn)及進(jìn)一步的影像學(xué)檢查,共有13例孕產(chǎn)婦符合深靜脈血栓形成的診斷,其中下肢深靜脈血栓形成12例,肺栓塞1例同時合并右下肢靜脈血栓形成,69.2%的患者存在除血液高凝外的其他導(dǎo)致深靜脈血栓形成的病史與高危因素。血液化驗纖維蛋白原定量(4.82±0.87)g/L,D-dimer定量(659.00±142)ng/ml,均超出參考值范圍,符合孕產(chǎn)婦高凝狀態(tài)及繼發(fā)纖溶亢進(jìn),所有的患者均進(jìn)行了抗凝治療,對肺栓塞患者采取了手術(shù)取栓治療,無出血并發(fā)癥,所有患者正常生存。2例為孕期發(fā)生深靜脈血栓,孕周分別為25周雙胎和38周單胎妊娠;雙胎孕25周患者行米索前列醇引產(chǎn)術(shù),孕38周單胎妊娠者行剖宮產(chǎn)終止妊娠。11例為產(chǎn)褥期發(fā)生,行抗凝治療后未觀察到產(chǎn)后出血(500ml/d)。所有患者中7例剖宮產(chǎn)終止妊娠,新生兒正常生存,6例陰道分娩,其中4例足月兒生存,2例行米索前列醇引產(chǎn)胎兒丟失。結(jié)論妊娠期及產(chǎn)褥期血液處于高凝狀態(tài),存在誘發(fā)因素時深靜脈血栓形成的風(fēng)險明顯增加,對于確診深靜脈血栓形成的孕產(chǎn)婦,抗凝治療是有效的措施;對于嚴(yán)重影響血流動力學(xué)穩(wěn)定的肺栓塞患者,手術(shù)取栓結(jié)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 鹵0.87 g / L D-dimer, 659.00 鹵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.
【作者單位】： 首都醫(yī)科大學(xué)附屬北京婦產(chǎn)醫(yī)院產(chǎn)科;中國醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)院心血管外科;
【分類號】：R714.252

【共引文獻(xiàn)】

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1 任維榕;祁興順;韓國宏;;布加綜合征與妊娠[J];臨床肝膽病雜志;2014年04期

2 劉芮汐;漆洪波;;產(chǎn)褥期靜脈血栓栓塞性疾病的診斷與處理[J];中華產(chǎn)科急救電子雜志;2014年02期

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本文編號：1886950