机械瓣膜置换术后孕期抗凝治疗13例分析

The analysis of 13 cases anticoagulant therapy during pregnancy after cardiac valve replacement

目的探讨心脏机械瓣膜置换术后孕期规范抗凝治疗的重要性及华法林对胚胎及胎儿影响。方法回顾性分析贵阳医学院附属医院和贵州省人民医院1995年10月至2008年2月收治的13例心脏机械瓣膜置换术后妊娠、分娩的病例资料。结果 8例孕期规范应用华法林抗凝治疗,1例孕中期心衰行瓣膜置换术后规范应用华法林抗凝治疗,该8例规范抗凝治疗过程中无孕产妇并发症发生;4例孕期自行将华法林减至孕前的1/2量,并发瓣膜血栓形成、心衰1例,产后出血1例;华法林剂量均<5mg/d;孕前自停抗凝药物5年1例,并发瓣膜血栓形成、心衰死亡;胎婴儿结局:流产、脑积水儿各2例;死胎3例,包括1例孕妇死亡胎儿同时丢失;华法林儿1例;正常新生儿5例。结论 (1)孕期不规范的抗凝治疗,使妊娠并发症发生率及不良妊娠结局发生增加。(2)华法林对胎儿发育存在不良影响,至少在孕早期和孕36周后宜停用华法林,而采用肝素类药物抗凝治疗。

Objective To investigated the importance of anticoagulant therapy during pregnancy with cardiac valve re- placement and the impact of warfarin on the embryo and fetus. Methods A retrospective study on 13 cases of pregnant women with mechanical heart valves was to be carried analysis, All these cases were in Affiliated Hospital of Guiyang Medical College and Guizhou Provincial People Hospital between October 1995 and February 2008. Results 8 cases of pregnancy regulated warfarin anticoagulant therapy, the second trimester because of heart failure after valve replacement line beginning warfarin therapy lcase. The eight cases of anticoagulant treatment had no maternal complications. 4 cases reduced the amount of warfarin of progestation to 1/2, concurrent valve thrombosis, heart failure 1 case, 1 case of postpar- tum hemorrhage. The dosage of warfarin 〈 5mg/d. 1 case stopped using warfarin five years progestation by herself, compli- cated with valve thrombosis, heart failure and death. Fetal outcome：abortion, hydrocephalus each 2 cases, fatal death 3 ca- ses, including one case of maternal mortality while fetal loss, and warfarin syndrome 1 case. 5 cases was normal children. Conclusion （1） The incorrect anticoagulant therapy during pregnancy will lead a higher proportion of complications and adverse pregnancy outcomes. （2） Warfarin will impact on fetal development, at least in early pregnancy and after 36 weeks it＇a proposed to stop anticoagulant warfarin, the proposed use of anticoagulant heparin.