妊娠期及产褥期16例易栓症的诊治分析

Diagnosis and treatment of thrombophilia during pregnancy or puerperium： A review of 16 cases

目的探讨妊娠期及产褥期易栓症的临床诊治与母儿结局。方法回顾性分析北京大学人民医院2006年7月—2015年2月妊娠期及产褥期16例易栓症患者的临床资料。结果主要表现为深静脉血栓栓塞症，其中12例为下肢深静脉血栓，3例肺栓塞，其中1例同时合并右下肢静脉血栓，1例肠系膜上静脉血栓。93．7％（15／16）的患者存在除血液高凝外的其他导致易栓症的高危因素，血液化验纤维蛋白原定量（416．04±114．9）mg／dl，D．dimer定量（2107．7±2266．6）ng/ml，符合孕产妇高凝状态及继发性纤溶亢进。4例为孕期发生的深静脉血栓，发病孕周为9～30＋2周；10例发生在产樨期；1例发生在中期妊娠引产术后；1例发生在阴道分娩时。所有患者中，阴道分娩5例（其中的3例是孕期发生静脉血栓的患者），剖宫产10例，1例胎死宫内行中期妊娠引产术，孕期静脉血栓的患者有2例在终止妊娠前放置下腔静脉滤网，均给予抗凝或溶栓治疗，随访至血栓消失，未遗留后遗症。15例新生儿均正常存活。结论妊娠期及产褥期血液处于高凝状态，存在易栓症高危因素时深静脉血栓形成的风险明显增加，加强对易栓症孕产妇的筛查与管理，对于改善母儿结局具有重要意义。

Objeetive To characterize thrombophilia during pregnancy and puerperium. Methods Clinical data were analyzed retrospectively between July 2006 and February 2015 in Peking University People＇ s Hospital. Results Sixteen eases were diagnosed with thrombophilia in gravidity or parturient according to the results of ultrasound Doppler scanning or computed tomography, including twelve cases of deep vein thrombosis of lower limbs, three cases of pulmonary embolism. Among which one eases was eomplieated with lower limb thrombosis, and the last one with superior mesenterie venous thrombosis. All cases detected higher value of plasma fibrinogen and D-Dimer. 93.7% （15/16） of the patients had other risk factors in addition to the high coagulation state. Anticoagulant therapy was used for all patients with low molecular weight heparin. Pulmonary artery embolectomy was done emergently in one patient combined with thrombolytic therapy. 10 cases were ended with Cesarean Section, five cases delivered by vagina （among which, three eases of vein thrombosis occurred in pregnancy）, and one case was induced abortion in second trimester. Two eases were placed with inferior vena eava filters before pregnancy termination. All newborns were healthy. Conclusion High coagulation state during pregnancy or puerperium is a risk factor of thrombophilia. It is important to recognize other risk factors of thrombophilia, to diagnose and treat the disease properly, in order to improve maternal and fetal outcomes.