妊娠期及产褥期下肢深静脉血栓形成10例临床资料分析

Analysis of the clinical data of 10 patients with vein thrombosis in gestation or puerperium

目的:探讨妊娠期及产褥期下肢深静脉血栓(DVT)形成的部位、类型、危险因素及治疗效果。方法:回顾分析2015年1月至2016年12月华中科技大学同济医学院附属同济医院妇产科收治的10例妊娠期及产褥期下肢DVT形成患者的临床资料。结果:下肢DVT患者10例,发生率为1.02/1000,妊娠期3例下肢DVT,形成部位位于髂外静脉及股静脉1例,右侧小腿肌间静脉1例,下肢深静脉1例;产褥期7例下肢DVT,形成部位位于小腿肌间静脉6例,胫后静脉1例。下肢DVT多见位于左侧,且肌间静脉血栓为最常见类型(7/10),其中6例为孤立性小腿肌间静脉血栓,1例为左侧腘窝浅静脉合并同侧多支小腿肌间静脉血栓形成。妊娠期及产褥期下肢DVT形成的常见危险因素包括剖宫产(9/10)、高龄(5/10)、BMI高(4/10)、长期卧床(4/10)、辅助生殖技术(3/10)。产褥期发现DVT时D-二聚体值较入院时明显升高(P<0.05)。患者发现DVT后均立即给予低分子肝素抗凝治疗并嘱穿弹力袜动态观察,监测凝血功能无明显异常。治疗至产后1~3月,患者症状缓解,复查下肢静脉彩超,静脉血栓消失。结论:妊娠期及产褥期具有下肢DVT形成的高危因素,尤其下肢肌间静脉血栓发生率高,应早期识别下肢DVT的症状明确诊断,尽早给予低分子肝素抗凝治疗,安全有效,预后良好。

Objective:To investigate the locations and types of venous thrombosis,risk factors,treatment and outcome during pregnancy and puerperium.Methods:The clinical datas of 10 patients with venous thromboembolism(VTE)during pregnancy and puerperium from Jan.2015 to Dec.2016 in our hospital were analyzed retrospectively.Results:The incidence of pregnancy-related VTE was 1.02/1000.Venous thrombosis occurred in 3 cases of pregnancy,1 case with femoral vein and external iliac vein,one case with calf muscle vein,and 1 case diagnosed as deep vein of lower limb.Seven cases were of VTE occurred in puerperium,the calf muscle venous thrombosis(CMVT)occurred in 6 cases and posterior tibial venous thrombosis occurred in one case.The incidence of CMVT was 70%(7/10),6 cases with isolated CMVT and one case with left axillary superficial vein combined with multiple CMVT.Deep vein thrombosis of the left lower limb was predominant.Common risk factors for venous thrombosis in pregnancy and puberty include cesarean section(9/10 cases),older age(5/10 cases),high BMI index(4/10 cases),bed rest(4/10 cases)and assisted reproductive technology(3/10 cases).The value of D-dimer was found significantly increase when the vein thrombosis was diagnosed in puerperium(P<0.05).All patients accepted treatment of low molecular weight heparin or were asked to wearing compression socks under dynamic monitoring.The total treatment was 1 to 3 months,and all patients got symptoms remission.The vein thrombosis was certified disappeared by ultrasound when finished the treatment.Conclusion:High risk factors of thrombosis were found during pregnancy and puerperium,the CMVT is predominant,symptoms of venous thrombosis should be identified as soon as possible,and most patients had good prognosis if diagnosed immediately and received optimal therapy.