妊娠晚期静脉血栓栓塞症的治疗及危险因素分析
| 作者: |
1卢敏,
2戚悠飞,
2陈浩,
1黄珊萍,
2肖占祥
1 海南省人民医院产科，海口570311 2 海南省人民医院血管外科，海口570311 |
| 通讯: |
卢敏
Email: qiyoufei3310@163.com |
| DOI: | 10.3978/.10.3978/j.issn.1005-6947.2016.12.017 |
| 基金: | 海南省自然科学基金资助项目, 814320 海南省卫生厅普通科研基金资助项目, 13A210303 |
摘要
目的：总结妊娠晚期静脉血栓栓塞症（VTE）的治疗经验，并分析相关危险因素。方法：回顾性分析2011年1月—2015年9月收治的43例妊娠晚期VTE患者，其中单纯深静脉血栓形成（DVT）35例，DVT合并肺血栓栓塞症（PTE）7例，单纯PTE 1例。总结其临床表现、治疗方式；以同期非VTE的妊娠晚期妇女43例为对照，分析VTE的相关危险因素。结果：所有患者予抗凝治疗，其中单纯抗凝治疗31例，足背浅静脉溶栓1例，胫后静脉穿刺导管接触溶栓3例，超声引导下腔静脉滤器置入2例，胫后静脉穿刺导管接触溶栓+下腔静脉滤器置入3例，胫后静脉穿刺导管接触溶栓+肺动脉碎栓+下腔静脉滤器置入3例。6例新生儿早产。治疗后，所有患者症状明显改善。随访期间，无症状性的DVT和PTE发作。单因素分析显示家族有血栓病史、吸烟、卧床久坐、初产妇、合并自身免疫性疾病、重度卵巢过度刺激征为妊娠晚期VTE发病的高危因素（均P<0.05）。结论：对于妊娠晚期VTE，抗凝是基础治疗，部分股青肿患者可以考虑导管接触溶栓，出现威及生命的PTE时，及时行肺动脉碎栓并放置下腔静脉滤器。对于高危孕妇，需积极预防VTE的发生。
关键词：
静脉血栓栓塞症
妊娠末期
危险因素
Management of venous thromboembolism in late pregnancy and risk factor analysis
CorrespondingAuthor:LU Min Email: qiyoufei3310@163.com
Abstract
Objective: To summarize the experience in treatment of venous thromboembolism (VTE) in late pregnancy and analyze the related risk factors. Methods: The clinical data of 43 women with VTE during late pregnancy treated from January 2011 to September 2015 were analyzed retrospectively. Of the patients, 35 cases had deep venous thrombosis (DVT),
7 cases had DVT and concomitant pulmonary thromboembolism (PTE), and one case had PTE only. The clinical manifestations and treatment methods of the patients were overviewed, and using women in late pregnancy without VTE during the same period as control, the related risk factors for VTE were analyzed. Results: All patients received anticoagulant therapy, 31 cases of them received lone anticoagulation therapy, and combined with thrombolytic therapy through superficial instep vein in 1 case, catheter-directed thrombolysis (CDT) through posterior tibial vein puncture in 3 cases, inferior vena cava filter (IVCF) implantation under ultrasound guidance in 2 cases, CDT plus IVCF implantation in 3 cases, and CDT plus IVCF implantation and catheter fragmentation of pulmonary embolism in 3 cases. Six infants had a premature delivery. After treatment, the symptoms were significantly improved in all patients. No symptomatic DVT or PTE occurred during follow-up. Family history of thrombosis, smoking, long-term bed rest, sedentariness, primipara were association with autoimmune disorders, and severe ovarian hyperstimulus syndrome were high risk factors for VTE during late pregnancy (all P<0.05). Conclusion: For patients with VTE in late pregnancy, anticoagulation is the basic treatment, and CDT should be performed in some cases with phlegmasia cerulean dolens, and catheter fragmentation of pulmonary embolism and IVCF implantation should be performed as soon as possible after an occurrence of PTE. Aggressive prevention should be considered for those pregnant women with high risk factors.
Keywords：
7 cases had DVT and concomitant pulmonary thromboembolism (PTE), and one case had PTE only. The clinical manifestations and treatment methods of the patients were overviewed, and using women in late pregnancy without VTE during the same period as control, the related risk factors for VTE were analyzed. Results: All patients received anticoagulant therapy, 31 cases of them received lone anticoagulation therapy, and combined with thrombolytic therapy through superficial instep vein in 1 case, catheter-directed thrombolysis (CDT) through posterior tibial vein puncture in 3 cases, inferior vena cava filter (IVCF) implantation under ultrasound guidance in 2 cases, CDT plus IVCF implantation in 3 cases, and CDT plus IVCF implantation and catheter fragmentation of pulmonary embolism in 3 cases. Six infants had a premature delivery. After treatment, the symptoms were significantly improved in all patients. No symptomatic DVT or PTE occurred during follow-up. Family history of thrombosis, smoking, long-term bed rest, sedentariness, primipara were association with autoimmune disorders, and severe ovarian hyperstimulus syndrome were high risk factors for VTE during late pregnancy (all P<0.05). Conclusion: For patients with VTE in late pregnancy, anticoagulation is the basic treatment, and CDT should be performed in some cases with phlegmasia cerulean dolens, and catheter fragmentation of pulmonary embolism and IVCF implantation should be performed as soon as possible after an occurrence of PTE. Aggressive prevention should be considered for those pregnant women with high risk factors.