围生期下肢深静脉血栓形成48例临床特征分析

Analysis on clinical features of perinatal deep venous thrombosis in 48 cases

目的分析围生期下肢深静脉血栓（DVT）形成的临床特征及预后。方法对48例围生期DVT患者临床资料进行回顾性分析其临床表现、发生时间、危险因素、影像学检查、治疗及母儿结局特征。结果 48例围生期DVT患者中,临床表现特征为患肢肿胀44例,疼痛或压痛46例,行动不便21例;左下肢发生DVT 25例,右下肢发生DVT 20例,双下肢发生DVT3例;DVT发生于肢体近端32例,肢体远端16例。DVT发生时间为产褥期39例,孕晚期5例,孕中期4例。孕期不规律产检或未进行产检14例,规律产检34例,发生DVT前卧床3 d及以上35例。并发产科疾病13例,其中产后出血4例,高血压疾病2例,糖尿病3例,羊水过少2例,甲亢2例。实验室检查D-2聚体阳性45例,血纤维蛋白原（Fbg）结果〉4 g/L 48例,凝血活酶时间（APr）和/或凝血酶原（PT）异常44例,血小板〉300×10^9/L 6例。结论围生期下肢静脉血栓形成与不规律产检、剖宫产、卧床时间、妊娠合并症、病理产科和内科疾病等多因素有关。

Objective To analyze the clinical features and prognosis of perinatal deep venous thrombosis（ DVT）. Methods The clinical manifestations,onset time,risk factors,imaging examination,treatment,maternal and infantile outcomes of 48 patients with perinatal DVT were analyzed. Results Among 48 cases with perinatal DVT,the clinical manifestations included swelling affected limb in 44 cases,pain or tenderness in 46 cases,limited activity in 21 cases; DVT occurred in left lower extremity of 25 cases,right lower extremity of 20 cases,and both lower extremities of 3 cases; DVT occurred in proximal limb of 32 cases and distal limb of 16 cases; DVT occurred during puerperium in39 cases,during late pregnancy in 5 cases,and during middle pregnancy in 4 cases. Among the cases,14 cases did not receive prenatal examination or regular prenatal examination,34 cases received regular prenatal examination,and 35 cases stayed in bed for 3 days or more than 3days. Thirteen cases were complicated with obstetric diseases,including 4 cases with postpartum hemorrhage,2 cases with hypertension,3 cases with diabetes,2 cases with oligohydramnios,and 2 cases with hyperthyroidism. Forty-five cases were found with positive D-dimer,the level of blood fibrinogen in 48 cases was more than 4 g / L,activated partial thromboplastin time（ APTT） and / or prothrombin time（ PT） in 44 cases were abnormal,PLT of 6 cases was more than 300×10^9/ L. Conclusion Perinatal DVT is correlated with regular prenatal examination,cesarean section,the time for staying in bed,pregnancy complications,pathological obstetric and internal medicine diseases.