CAJ | 학술논문

目的探讨妊娠合并深静脉血栓形成(DVT)的病因和治疗措施.方法回顾性分析中山大学附属第一医院1991-2010年29例住院妊娠合并DVT患者的临床资料,从诱因、病变部位、治疗方法、预后以及妊娠情况进行分析.结果 DVT在早期妊娠期的发生率为69.0%(20/29).首位诱因为既往DVT病史,占所有诱发因素的24%(7/29);发生多左下肢,发生率为82.8%(24/29).抗凝是治疗的主要原则,首诊均采用肝素或低分子肝素(LMWH)抗凝治疗.7例患者一直采用LMWH治疗直至分娩前,胎儿发育正常;11例早期、2例中期患者于妊娠中期改为口服华法令,至孕34周左右改为LMWH,其中4例胎儿死亡,其余胎儿发育正常;9例早期患者选择终止妊娠.结论出于孕妇和胎儿的安全考虑,妊娠DVT的治疗与一般DVT患者不同,LMWH或肝素抗凝是妊娠DVT治疗的安全有效措施.临床工作中应重视该疾病治疗的特殊性.
목적 탐토임신합병심정맥혈전형성(DVT)적병인화치료조시.방법 회고성분석중산대학부속제일의원1991-2010년29례주원임신합병DVT환자적림상자료,종유인、병변부위、치료방법 、예후이급임신정황진행분석.결과 DVT재조기임신기적발생솔위69.0%(20/29).수위유인위기왕DVT병사,점소유유발인소적24%(7/29);발생다좌하지,발생솔위82.8%(24/29).항응시치료적주요원칙,수진균채용간소혹저분자간소(LMWH)항응치료.7례환자일직채용LMWH치료직지분면전,태인발육정상;11례조기、2례중기환자우임신중기개위구복화법령,지잉34주좌우개위LMWH,기중4례태인사망,기여태인발육정상;9례조기환자선택종지임신.결론 출우잉부화태인적안전고필,임신DVT적치료여일반DVT환자불동,LMWH혹간소항응시임신DVT치료적안전유효조시.림상공작중응중시해질병치료적특수성.
Objective To summarize the epidemiology and risk factors of deep venous thrombosis (DVT) during pregnancy and develop therapeutic strategies. Methods Twenty-nine pregnant women with DVT were admitted into our hospital between 1991 and 2010. And their clinical data were retrospectively reviewed. Results Among all cases, the occurrence (69%, 20/29) of DVT in the first trimester was highest as compared with those in the second and third trimesters. A previous history of DVT was a leading risk factor ( 24%, 7/29 ) . Twenty-four cases ( 82. 8%, 24/29 ) involved left lower extremities.Anticoagulation was the primary therapy. All cases were initially intravenously administrated with unfractioned heparin (UFH) or injected subcutaneously with low-molecule-weight heparin (LMWH).LMWH continued throughtout pregnancy in 7 cases. The fetus had a normal development. Due to financial problems, 11 cases in the first trimester and 2 cases in the second trimester switched to oral warfarin from LMWH after the initial treatment. And warfarin was substituted by LMWH by Week 34. However the fetuses died in 4 cases while the other fetuses were normal. Nine cases in the first trimester decided to terminate pregnancy. Conclusion Treatment decisions during pregnancy carry potential implications for both maternal and fetal health and life. Therefore the DVT strategies during pregnancy differ from those during nonpregnancy. Special cautions should be exercised for the treatment of DVT during pregnancy.