孕产期静脉血栓栓塞性疾病临床分析

Clinical analysis of venous thromboembolism during the pregnant and puer-peral period

目的探讨孕产期静脉血栓栓塞性疾病(VTE)的临床特点及诊治方法。方法回顾性分析本院2002年4月至2013年9月间收治的130例合并VTE的孕产期患者临床资料,并结合文献复习讨论其病因及诊治方法。结果孕产期VTE的辅助诊断首选血浆D-二聚体检测结合彩色多普勒超声显像(静脉超声/心脏超声并评估肺动脉压力),必要时进行肺动脉CT检查。采用全身或局部抗凝、溶栓等药物或置管溶栓治疗,46例患者放置可回收性下腔静脉滤器(IVCF)预防致死性肺栓塞,均取得较好的近期疗效。结论孕产期VTE患者低分子肝素抗凝治疗安全有效,华法林在妊振期禁用,在哺乳期可酌情使用,并严格掌握孕产期VTE患者的IVCF放置指征。

Objective To investigate clincal features,diagnosis and treatment of venous thromboembolism (VTE ) during the pregnant and puer-peral period. Methods Clinical data and treatment methods of 130 patients with VTE during the pregnant and puer-peral period from April 2002 to September 2013 were analyzed retrospectively. After reviewing the previous literature, pathogenesis, diagnosis and treatment were discussed. Results Combination of plasma D-dimmer and Doppler ultrasonography (venous ultrasonography/cardiac uhrasonography and assessment of pulmonary artery pressure) was the best choice to diagnose VTE. Pulmonary artery CT was performed if necessary. Systemic or local anticoagulation thrombolysis or catheter-directed thrombolysis was effective for VTE during the pregnant and puer-peral period. Inferior vena cava filters (IVCFs) were applied for the suspected patients to prevent fatal PE. Conclusions For patients with VTE during the pregnant and puer-peral period, low molecular weight heparin is safe and effctive. Warfarin is forbidden in pregnancy but selectively used in lactation. The indication of IVCFs placement should be strictly controlled.