孕产妇合并肺栓塞临床特点分析  

Clinical features of pulmonary embolism during pregnancy or the postpartum period

作　　者：王新霞[1] 李燕娜[2] 刘双[1] 杨京华[1] 张大伟[2] WANG Xinxia;LIU Shuang;LI Yanna(Department of Respiratory and critical Care,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所呼吸与危重症科,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所妇产科,100029

出　　处：《心肺血管病杂志》2019年第9期928-932,941,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:分析孕产妇合并肺栓塞的临床特点。方法:对12例孕产妇合并肺栓塞患者的临床资料,临床症状、辅助检查、治疗措施及妊娠结局进行回顾性分析。12例患者危险分层为:1例高危,7例中高危,2例中低危,2例低危。结果:①发病时间:妊娠早期2例,妊娠中期1例,妊娠晚期3例,剖宫产术后4例,死胎引产后1例,人工流产清宫术后1例。②终止妊娠方式:剖宫产9例,利凡诺引产1例,死胎后利凡诺引产1例,人工流产清宫术后1例。③治疗:1例溶栓治疗,余低分子肝素(LMWH)抗凝治疗,中早期妊娠患者抗凝3个月,晚期妊娠患者产后即可选择华法令序贯抗凝,1例选用利伐沙班抗凝,过程中出现大出血。④孕妇均存活,健康足月儿9例,早产儿1例,死胎3例。结论:提高对妊娠及产后合并肺栓塞疾病的认识,尽早确诊和治疗。Objective: To analyze the clinical features of pulmonary embolism(PE) during pregnancy or the postpartum period.Method : 12 patients Clinical data of pregnant or postpartum women with PE, were collected for the study. The clinical symptoms, adjuvant examinations, treatment measures and outcomes were retrospectively analyzed. The risk stratification of 12 patients was 1 high risk, 7 medium high risk, 2 medium low risk and 2 low risk. Results: Onset time of PE: 2 cases occurred in the first trimester of pregnancy,1 case in the second trimester of pregnancy,3 cases in the third trimester of pregnancy,4 cases in the puerperal period after caesarean section, 1 case in the period after post-stillbirth induced labor, and 1 case after artificial abortion curettage. Methods: of pregnancy termination: 9 cases chosed cesarean section to insure the newborns’ safe,1 case chosed abortion by injecting rivanol,1 case chosed abortion by injecting rivanol after stillbirth,and 1 case occurred induced abortion by dilatation and curettage.③Treatment: 1 case was treated with thrombolytic therapy, the remaining LMWH anticoagulant therapy, the early and middle pregnancy patients with anticoagulation for 3 months, the late pregnancy patients can choose Warfarin sequential anticoagulation after delivery,Rivaroxaban was used as anticoagulant in 1 case, and massive hemorrhage occurred in the process.④Outcomes: All maternals survived;9 newborns were healthy term infants,1 newborn was premature,and 3 stillbirths. Conclusion : Our research made a little contribution to the understanding of PE during pregnancy or postpartum period, which needs early diagnosis and treatment.

关 键 词：妊娠 肺栓塞 高危 

分 类 号：R54[医药卫生—心血管疾病]