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目的:探讨妊娠合并静脉血栓栓塞性疾病的临床治疗措施及预后情况。方法:回顾性分析了2010年6月~2012年12月东阳市妇幼保健院23例静脉血栓栓塞性疾病孕产妇资料,探讨孕产妇静脉血栓栓塞性疾病的临床治疗方法。结果:23例静脉血栓栓塞性疾病患者均采用支持治疗和抗凝治疗,4例下肢深静脉血栓患者,1例下肢深静脉血栓合并肺栓塞患者和1例肺栓塞患者均给予溶栓治疗和中医配合治疗,所有下肢深静脉血栓患者经治疗后临床症状和体征均明显好转。1例下肢深静脉血栓合并肺栓塞患者和1例肺栓塞患者在治疗后呼吸系统症状基本消失,出院后3个月肺动脉压力基本恢复正常。其中显效16例,有效6例,无效1例,总有效率达95.65%。治疗后的患肢周径(3.54±0.78)cm明显低于治疗前的(4.12±0.67)cm,差异具有统计学意义(t=4.31,P<0.05)。23例患者中经阴道分娩10例,剖宫产13例;治疗期间所有患者均未见明显出血症状;所有新生儿均无畸形、无窒息,出院后随访6~12个月,所有患者的静脉血栓经复查均无明显蔓延,临床症状未见反复。结论:采用低分子肝素进行抗凝治疗妊娠合并静脉血栓栓塞性疾病是安全有效的,妊娠合并静脉血栓栓塞性疾病不是终止妊娠的指征;对于妊娠合并静脉血栓栓塞性疾病应以预防为主,产前的科学保健和产后的严密观察可以减少发病率,早期发现及诊治妊娠期疾病,保障妊娠期健康。
Objective: To investigate the clinical treatment and prognosis of pregnancy complicated with venous thromboembolism. Methods: A retrospective analysis of maternal and child health information on 23 cases of venous thromboembolism in Dongyang MCH from June 2010 to December 2012 was conducted to investigate the clinical treatment of venous thromboembolism in pregnant women. Results: Twenty-three patients with venous thromboembolism were treated with supportive therapy and anticoagulant therapy. Four patients with deep venous thrombosis of lower extremity, one patient with deep venous thrombosis complicated with pulmonary embolism and one patient with pulmonary embolism were treated with thrombolytic therapy and Chinese medicine With the treatment, all patients with deep vein thrombosis after treatment of clinical symptoms and signs were significantly improved. One case of deep venous thrombosis with pulmonary embolism and one case of pulmonary embolism in patients with respiratory symptoms disappeared after treatment, 3 months after discharge of pulmonary artery pressure returned to normal. Among them, 16 cases were markedly effective, 6 effective and 1 ineffective, with a total effective rate of 95.65%. The peripheral diameter of the affected limbs (3.54 ± 0.78) cm was significantly lower than that before treatment (4.12 ± 0.67) cm, the difference was statistically significant (t = 4.31, P <0.05). Among the 23 patients, 10 were vaginal delivered and 13 were cesarean; all patients had no obvious hemorrhagic symptoms during the treatment. All newborns were normal and asphyxiated, and were followed up for 6 to 12 months after discharge. All the patients had veins No significant recurrence of thrombus after the review, no clinical symptoms were repeated. Conclusion: The anticoagulant therapy with low molecular weight heparin is safe and effective in the treatment of pregnancy complicated with venous thromboembolism. Pregnancy complicated with venous thromboembolism in pregnancy is not an indication of termination of pregnancy. For the prevention and treatment of venous thromboembolism in pregnancy, Prenatal scientific health care and close observation of postpartum can reduce the incidence of early detection and treatment of pregnancy diseases, to ensure the health during pregnancy.