心脏瓣膜置换术后妇女妊娠全程口服华法令抗凝观察103例

Observation on Therapeutic Effect of Warfarin on 103 Pregnant Women with Prosthetic Mechanical Heart Valves Throughout Pregnancy

目的探讨心脏机械瓣膜置换术后的妊娠妇女全程使用华法令抗凝对孕妇及胎儿的影响。方法随访1998年4月至2010年6月中南大学湘雅二医院103例心脏机械瓣膜置换术后妇女妊娠阶段抗凝治疗的情况,年龄19~38岁（26.4±3.8岁）。103例机械瓣置换患者整个妊娠期均采用口服华法令抗凝治疗,其中国产华法令用量为3.30±0.43 mg/d（87例）,进口华法令用量为2.90±1.05 mg/d（16例）。结果 103例患者妊娠期间均无严重栓塞并发症,发生腹腔自发性出血1例;宫内死胎4例;出生的新生儿中发生胎儿畸形5例,其中21-三体综合征1例,脑积水4例;ABO血型不合溶血1例,低体重新生儿6例;其余新生儿未见异常,体重正常;所有产妇无产后大出血。结论机械瓣膜置换术后妇女在妊娠期间,单一服用小剂量华法令（〈5 mg/d）为一种相对安全有效的抗凝治疗。

Objective To investigate the anticoagulation effect of warfarin on pregnant women with prosthetic mechanical heart valves during the whole course of pregnancy and their fetuses.Methods Follow-up survey was carried out on 103 pregnant women with prosthetic mechanical heart valves treated in the Second Xiangya Hospital of Central South University from April 1998 to June 2010.Their age ranged from 19 and 38 years（26.4±3.8 years）.All the 103 pregnant women were given oral administration of warfarin during the whole course of pregnancy.The average dose of domestic warfarin was 3.30±0.43 mg/d（87 cases）,while the average dose of imported warfarin was 2.90±1.05 mg/d（16 cases）.Results None of the patients suffered from serious embolic events.One patient suffered from spontaneous peritoneal hemorrhage.There were 4 cases of intrauterine deaths,and 5 cases of fetal malformation including 1 case of Down＇s syndrome and 4 cases of hydrocephalus.Six cases of low birth weight infants and 1 case of ABO hemolytic disease were also found.All the other neonates were healthy with normal weight.No pregnant women suffered from postpartum hemorrhage.Conclusion Oral administration of low dose warfarin（5 mg/d） during the whole course of pregnancy is a relative safe and effective anticoagulation protocol.