心脏机械瓣膜置换后妊娠期抗凝药物的使用

The follow up of pregnant women with anticoagulation therapy after mechanical heart valve replacement

目的:探讨心脏机械瓣膜置换术后妊娠期使用抗凝药的方法及安全性。方法:回顾性分析48例心脏机械瓣膜置换术后孕妇52次妊娠的3种不同抗凝方案的妊娠结局。A组35例整个孕期口服华法令;B组8例怀孕后由口服华法令改服潘生丁;C组5例于孕36周由口服华法令改用肝素。结果:52次妊娠总的妊娠丢失率7.69%,剖宫产率91.67%。无1例孕产妇及围产儿死亡和新生儿畸形,A组和B组各发生1例产后出血,B组有较高的血栓形成发生率。C组平均住院天数明显长于A、B组,差异均有显著性意义(P<0.001)。结论:心脏机械瓣膜置换后孕妇在严密监护下口服低浓度的华法令是安全和方便的。

Objective： To explore the methods and safety of anticoagulation in pregnant women with mechanical heart valve replacement （MVR） . Methods： The outcome of three kinds of anticoagulation was followed up respectively in 48 pregnant women with MVR. Group A ： 35cases took Warfarin during the whole pregnancy ; Group B ： 8 cases took Persantin instead of Warfarin after pregnancy; Group C ： 5 cases were injected low - weight haprine after 36 weeks gestation who were took Warfarin. Results： Miscarrige rate was 7. 69%. Cesearea section rate was 91.67%. No petipartum death and abnormal fetus occurred. Rate of thromboembolism and mean admission days were significant difference. Otherwise, cesearea section rate and postpartum hemorrhage was not significantly different. Conclusion： The anticoagulation therapy with low dosage of Warfarin is safe and convenient for the mothers during pregnancy following MVR and has no abnormal fetus found.