妊娠中晚期静脉血栓栓塞性疾病10例临床分析

Clinical analysis of 10 patients with venous thromboembolism during mid-and late pregnancy

目的探讨妊娠中晚期静脉血栓栓塞性疾病(venous thromboembolism,VTE)形成的特点、危险因素及治疗效果,加强对妊娠期VTE的认识并提高诊疗水平。方法回顾性分析2018年5月至2021年5月在同济大学附属第一妇婴保健院分娩的41050例孕妇,对妊娠期发生VTE的患者进行临床特点分析。结果有10例VTE患者均发生于妊娠中晚期,发生率约为0.24/1000。下肢深静脉血栓(deep vein thrombosis,DVT)位于小腿肌间静脉者5例,股静脉1例,腘静脉1例。肺血栓栓塞(pulmonary thromboembolism,PTE)患者血栓形成位于左侧肺动脉分支者1例,左侧肺动脉主干者1例,右侧肺动脉分支者3例,双侧肺动脉主干及分支多发栓塞者1例。10例妊娠期VTE主要危险因素有:高龄(≥35岁)、制动/长期卧床、辅助生殖技术、多胎妊娠、下肢静脉曲张。患者确诊VTE后均立即给予低分子肝素抗凝治疗,并动态监测凝血功能变化。患者均经剖宫产终止妊娠,抗凝治疗至产后1~3月,产后均未再发生血栓。结论妊娠期VTE发生率较低,但诸多危险因素可促进血栓发生,应积极预防,早期识别与诊断,尽早给予规范化抗凝措施。

Objective To investigate the characteristics,risk factors and treatment of venous thromboembolism(VTE)in second and third trimester of pregnancy,so as to strengthen the understanding of VTE during pregnancy and improve the level of diagnosis and treatment.Methods A retrospective analysis of 41050 pregnant women who gave birth in the First Affiliated Maternal and Infant Hospital of Tongji University from May 2018 to May 2021 was performed,and the clinical characteristic of patients with VTE during pregnancy were analyzed.Results Ten cases of VTE occurred in the second and third trimesters of pregnancy,and the incidence was about 0.24/1000.Deep vein thrombosis(DVT)of lower extremity was located in the intermuscular vein of the calf in five cases,femoral vein in 1 case and popliteal vein in 1 case.Pulmonary thromboembolism(PTE)patients had thrombus located in the left pulmonary artery branch in 1 case,the left main pulmonary artery in 1 case,the right pulmonary artery branch in 3 cases,and the bilateral main pulmonary artery and branch embolism in 1 case.The main risk factors of VTE during pregnancy in 10 cases were:adcanced age(≥35 years old),immobilization/long-term bed rest,assisted reproductive technology,multiple pregnancy,and varicose veins of lower extremities.All patients were given low-molecular-weight heparin(LMWH)anticoagulation therapy immediately after the diagnosis of VTE,and the changes of coagulation function were dynamically monitored.The pregnancy was terminated by cesarean section In all patients,and the anticoagulation therapy was performed until 1 to 3 months after delivery,and no thrombosis occurred after delivery.Conclusions Although the incidence of VTE during pregnancy is low,but many risk factors during pregnancy can promote the occurrence of thrombosis.Active prevention,early identification and diagnosis and standardized anticoagulation measures should be given as soon as possible.