孕产期易栓症与肺栓塞的诊治

The diagnosis and treatment of thrombophilia and pulmonary venous thromboembolism

妊娠期血液高凝状态是分娩的生理准备,但血液高凝状态使静脉血栓栓塞(venous thrombo embolism,VTE)的危险性增加,围产期VTE已成孕产妇死亡主要原因。易栓症是VTE的危险因素,发病因素包括遗传性和获得性。尽管目前已从基因水平对易栓症的发病因素有了新的认识,但对妊娠期易栓症的全面筛查在临床上是不合理的。因此对孕产妇整个妊娠期及产后的血栓形成的危险因素进行评估,据其情况提供个体化的预防措施是关键。但是血栓的预防性抗凝治疗目前尚有争议,对VTE预防性治疗对象、时机以及方法尚未统一,是否启动预防性抗凝治疗有待进一步研究。肺栓塞(pulmonary em-bolism,PE)发病急骤,易漏诊及误诊,重要的是提高对PE的认识。对于高度怀疑PE者,应立即开始抗凝治疗。目前无妊娠期使用抗凝剂的统一标准,过度会导致出血不止,不足仍有血栓再发的风险。

The maternal hypereoagulable state is a physiological preparation for delivery. However, this hypereoagulability is as- sociated with an increased risk of venous thromboembolism （VTE）. VTE is a leading cause of maternal mortality. Inherited and ac- quired thrombophilia is the risk factor related to VTE. Although new understandings of pathogenic factors of thrombophilia in terms of gene level have been achieved, universal screening for thrombophilia in pregnancy is not reasonable in the clinical setting. Risk assess- ment should be done to establish the need for thromboprophylaxis during pregnancy and the postpartum period. All pregnant women with thrombophilia should undergo individualized prophylaxis strategies. However, the prophylactic anticoagulation regimen is controversial. The VTE preventive treatment object, time, and method are still not unified. There is insufficient evidence to support initiation of prophy- lactic anticoagulation. Pulmonary embolism （PE） is progressing rapidly with high false-negative and false-positive results. It is crucial to reinforce the knowledge of PE. If PE is suspected, treatment with anticoagnlation should be started immediately. However, anticoagulant drugs have no clinical criteria. Bleeding will occur with excessive dosage while thromboembolism will recur with inadequate dosage.