妊娠期及产褥期静脉血栓12例临床分析

Clinical Analysis of 12 Cases with Venous Thromboembolism during Pregnancy and Puerperium

目的探讨妊娠期和产褥期静脉血栓的发生率、病因、诊断、预防和治疗。方法回顾性分析1984年1月至1997年12月间，我院住院诊治的12例妊娠期及产褥期深静脉血栓栓塞患者的临床资料，并对4例患者进行蛋白C、蛋白S、抗凝血酶Ⅲ活性和活化蛋白C抵抗（APC-R）的测定，同时进行凝血因子V（FV）1691位核苷酸基因变异（FVLiden变异）筛选。结果4例血栓发生在妊娠期，8例发生在产褥期；2例合并肺栓塞，1例死亡；APC－R（＋）、抗凝血酶Ⅲ及蛋白S活性减低各1例，在观察的4例中未发现FVLeiden变异。经过溶栓等治疗，11例预后良好。结论妊娠期抗凝蛋白缺陷与静脉血栓栓塞的形成密切相关。静脉血栓栓塞的首选治疗方法是抗凝治疗。

Objective To study the incidence, cause and clinical manifestation of venous thromboembolism during pregnancy and puerpenum,and its diagnosis and treatment,Methods 12 cases of venous thromboembolism admitted in our hospital from 1984-1997 were analysed retrospectively. The plasma protein C,protein S and antithrombin Ⅲ activities were measured in 4 of the cases and activated protein C resistance (APC-R) were assayed by activated partial thrombinplastin time (APTT) in the presence and absence of APC (APC-APTT)and FV Leiden gene mutation were analysed by PCR restrichon fragment length polymorphisms (RFLP) the as well. Results Four cases occurred before dalivery and 8 postpartum Two cases complicated by pulmonary thromboembolism, and of them 1 died. APC-R(+ ), reduced activity of antithrombin -Ⅲ and protein S each were found in 3 separate cases. No FV Leiden gene mutation was found in the 4 cases. Conclusions The formation of venous thromboembolism during pregnancy and puerperium is highly associated with the deficiency of anticoagulant proteins.Anticoagulation is recommedned in the high risk women of thromboembolism.