心瓣膜置换术后孕产妇抗凝治疗(附183例临床报道)  

Anticoagulation for pregnant patients with prosthetic heart valves(183 cases)

作　　者：喻杰峰[1] 胡建国[1] 周新民[1] 蒋玲[1] 唐浩[1] 

机构地区：[1]中南大学湘雅二医院胸心外科,湖南长沙410011

出　　处：《中国现代医学杂志》2009年第11期1713-1715,共3页China Journal of Modern Medicine

摘　　要：目的总结探讨心脏瓣膜置换术后孕产妇抗凝治疗的经验。方法回顾总结分析183例心脏瓣膜置换术后孕产妇抗凝治疗的方法及其妊娠结局。结果183例患者,共194次妊娠。22例患者(33次妊娠)于早孕期人流术终止妊娠,继续妊娠的161例中有72例选择持续低强度华法令口服抗凝治疗,89例患者选择肝素-华法令抗凝,孕12周前使用低分子肝素抗凝;华法令剂量为1.0～2.5mg/d,轻微出血5例,无栓塞并发症。孕中期妊娠意外2例;无多胎,159新生儿中早产2例、先天畸形1例;剖宫产101例、阴道产58。结论孕前12周改低分子肝素抗凝可安全应用于心脏瓣膜置换术后孕产妇的抗凝治疗,妊娠期间低强度华法令持续口服抗凝治疗实施更为方便,亦可应用于此类特殊人群抗凝治疗。[Objective] To summary the chnical experience of anticoagulation therapy for prosthetic heart valves in pregnancy. [Method] The anticoagttlation treatments and outcome of pregnancy in 183 pregnant patients with prosthetic heart valves were reviewed retrospectively. [Results] 194 gestations were reviewed, and 33 of them （22 patients） were aborted at early period of pregnancy. Low intensity of continuous oral Warfarin therapy without low molecular weight Hepafin （LMWH） was applied in 72 patients, LMWH-Warfarin therapy （LMWH treated at the first 12 weeks of pregnancy, followed by oral Warfarin lasting to 2 weeks before the delivery） was used in 89 patients. The dosage of Warfarin ranged from 1.0 mg/d to 2.5 mg/d. No antieoagulafion comphcations but mild bleeding in 5 patients were observed. 2 gestations were aborted at the middle period of pregnancy cause of still birth or anencephaly. Among 159 neonates, 2 were premature and 1 with congenital disorder. [Conclusions] The LMWH-Warfarin therapy can be used safely in pregnant patients with prosthetic heart valves, while the low intensity of continuous oral Warfarin therapy, which is more convenient, is an alternative antieoagulation selection for this special group.

关 键 词：心脏 人工瓣膜 抗凝 妊娠 

分 类 号：R654.27[医药卫生—外科学]