足月分娩产妇下肢深静脉超声数据及血液指标的探讨  

Lower limb deep vein ultrasonography and blood biochemistry in women after full-term delivery

作　　者：裘毓雯[1] 陈翠华[1] 孙桂芹[1] 钟梅[1] 李颖嘉[2] 王辰[3] 汪丽萍[1] 

机构地区：[1]南方医科大学南方医院妇产科,广东广州510515 [2]南方医科大学南方医院超声科,广东广州510515 [3]首都医科大学附属北京朝阳医院/北京呼吸疾病研究所,北京100020

出　　处：《南方医科大学学报》2009年第5期933-935,共3页Journal of Southern Medical University

基　　金："十五"国家科技攻关项目(2001BA703B15);国家"十一五"科技支撑项目(2006BAI01A06);广东省科技计划项目(2007B030502015)

摘　　要：目的观察产后2～5d足月分娩产妇下肢深静脉超声及血液指标的变化,探讨其临床意义。方法对具血栓形成高危因素产后2～5d足月分娩产妇212例(A组)、健康产后2～5d足月分娩产妇77例(B组)及健康非孕妇女42例(C组)进行各项血液指标监测,包括D-二聚体(D-D)、血小板(PLT)、血红蛋白(HGB)、红细胞压积(HCT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、血浆凝血酶原时间(PT)、纤维蛋白原(Fbg)值;同时应用高分辨率彩色多普勒超声(CDU)对3组妇女双下肢深静脉内径及血流速度进行检查。结果A组较B组左/右侧股静脉(FV)内径、左/右侧股浅静脉(SFV)内径、左/右侧腘静脉(POV)内径显著增宽,D-D显著增高,差异有统计学意义(P<0.01);左/右侧POV血流频谱峰值降低,差异有统计学意义(P<0.05);A组、B组分别与C组比较,左/右侧FV、SFV、POV、胫后静脉(PTV)内径均显著增宽,左/右侧FV、左/右侧POV血流频谱峰值均显著降低,PLT、HGB、HCT、D-D、TT、APTT、PT、Fbg均有显著变化,差异有统计学意义(P<0.01)。结论产后2～5d足月分娩产妇较健康非孕妇女处于明显的血栓前状态,而产后2～5d高危足月分娩产妇较健康同期产妇更易处于血栓前状态。彩色多普勒超声下肢深静脉检查可作为高危产妇筛查指标之一。Objective To observe the postpartum changes in lower limb deep vein ultrasonography and blood biochemistry in women 2-5 days after full-term delivery. Methods A total of 212 women at high risk of thrombosis underwent high-resolution color Doppler ultrasound （CDU） of the lower limb deep veins 2-5 days after full-term delivery （Group A）. Sixty-one healthy women 2-5 days after full-term delivery （Group B） and 42 healthy non-pregnant women （Group C） were recruited as the controls. The hematological indexes including the D-dimers （D-D）, platelet （PLT）, hemoglobin （HGB）, hematocrit （HCT）, thrombin time （TT）, activated partial thromboplastin time （APTT）, prothrombin time （PT） and fibrinogen （Fbg） were also determined in these 3 groups. Results Compared to Group B, the women in group A showed significantly increased diameters and D-D value of the common femoral veins （FV）, common superficial femoral veins （SFV） and common popliteal veins （POV） （P〈0.01）, with decreased peak blood flow in the bilateral POVs （P〈0.05）. Compared to those in Groups C, the diameters of the bilateral FVs, SFVs, POVs, and posterior tibial veins （PTVs） were significantly increased, but the peak blood flow in the bilateral FVs, SFVs, and POVs were significantly reduced in groups A and B; the PLT, HGB, HCT, DD, TT, APTT, PT, and Fbg also showed significant changes in groups A and B （P〈0.01）. Conclusions The women 2-5 days after full-term delivery are at high risk of prethrombotic state in comparison with non-pregnant women, and the presence of high-risk factors for thrombosis increases the likeliness ofprothrombotic state in these postpartum women. CDU examination of the lower limb deep veins can be of value in the diagnosis ofprethrombotic state.

关 键 词：高危产妇 血栓前状态 D-二聚体 彩色多普勒超声 

分 类 号：R714.3[医药卫生—妇产科学] R445.1[医药卫生—临床医学]