围生期静脉血栓栓塞症42例临床诊治剖析.docVIP

围生期静脉血栓栓塞症42例临床诊治剖析 　　[摘要] 目的 探讨围生期静脉血栓栓塞症的诊治、预防措施及母婴预后。 方法 对广州医学院第三附属医院2009年1月～ 2014年1月42例围生期的临床资料进行回顾性分析 。 结果 （1）其中37例多普勒彩色超声（88.1%）确诊，5例（11.9%）患者静脉彩色多普勒超声提示血栓形成阴性，行MRI提示血栓形成阳性确诊。左下肢血栓形成32例（76.2%），右下肢血栓形成9例（21.4%），双下肢血栓形成1例（2.4%），33例（78.6%）为中央型，3例（9.5%）为周围型，5例 （11.9%）为混合型。（2）治疗：42例用低分子肝素抗凝治疗，11例行静脉滤器置入术，其中6例行插管溶栓，未有致死性肺栓塞发生，所有患者经系统治疗后均好转出院；行插管溶栓患者其72h、3个月、6个月血管再通情况均明显优于单纯抗凝患者，差异具有统计学意义（P0.05）。 结论 围生期是静脉血栓栓塞症的高发期，可致严重并发症，必须根据具体不同的孕期情况选择合适的治疗方案，在抗凝的基础上积极地溶栓处理，预防、减少并发症的发生，从而改善母婴的结局及减少深静脉血栓后遗症的发生。 　　[关键词] 围生期；深静脉血栓形成；预防；治疗 　　[中图分类号] R714.7 [文献标识码] A [文章编号] 2095-0616（2015）06-18-05 　　Clinical analysis of diagnosis and treatment of 42 cases with venous thromboembolism （VTE） in perinatal period 　　LUO Xitu1，2 YANG Chengyu1 LIU Zhengjun2 　　1.Department of General Surgery， the Third Affiliated Hospital of Guangzhou Medical University， Guangzhou 510150， China；2.Southern Medical University， Guangzhou 510515， China 　　[Abstract] Objective To study the diagnosis and treatment， the preventive measures and the maternal-neonatal outcomes of VTE in perinatal period. Methods 42 cases with VTE in perinatal period who were treated in the Third Affiliated Hospital of Guangzhou Medical University between January 2009 and January 2014 were analyzed retrospectively. Results （1）37 cases （88.1%） were diagnosed with color Doppler imaging， 5 cases were diagnosed with MRI which suggested that thrombosis positive while color Doppler imaging suggested that thrombosis negative. There were 32 cases （76.2%） with thrombosis in left lower extremity， 9 cases （21.4%） with thrombosis in right lower extremity， 1 case （2.4%） with thrombosis in both lower limbs， 33 cases （78.6%）with central thrombosis， 3 cases （9.5%） with peripheral thrombosis and 5 cases （11.9%） with mixed thrombosis. （2）Treatment：42 cases were treated with anticoagulant therapy of low molecular weight heparin （LMWH）， 11 cases were treated with inferior vena cava filters insertion， 6 cases were treated with catheter thrombolysis. Th