孕产妇围生期下肢深静脉血栓形成的临床特征

摘要

Objective:To investigate the clinical characteristics of lower extremity deep venous thrombosis of pregnant women in perinatal period,in order to reduce the perinatal formation stage of deep venous thrombosis of lower extremity and reduce the maternal mortality rate.Methods:22 patients with perinatal lower extremity deep vein thrombosis were selected from February 2011 to April 2014.We summarized and analyzed the age,pregnancy history,time of onset,symptoms,occurrence site and other datas of them.Results:7 patients were occurred during pregnancy,and the pregnancy time was 4~31 weeks,averaged 12.2 weeks;15 cases were occurred during puerperal,among them,11 cases were occurred after cesarean section,4 cases were occurred after vaginal delivery from the occurrence of postpartum ranging from 3~40 d,averaged 25.1 d.19 cases in the left lower extremity,3 cases occurred in the right lower limb.Vein occurred:occurred in the posterior tibial vein in 1 case,occurred in the saphenous vein in 2 cases,2 cases occurred in the popliteal vein,femoral vein occurred in 2 cases,15 cases occurred in the external iliac vein.The limb swelling,pain,tenderness,fever symptoms in different degree.12 cases of the pregnant women lying in bed time after cesarean section or vaginal delivery>3 d.Complications:11 cases of postpartum hemorrhage,4 cases with preeclampsia,2 cases of twin pregnancy,recurrent abortion 7 cases,22 cases were diagnosed by color Doppler.Auxiliary examination:a small number of patients with abnormal activated partial thromboplastin time(APTT) and prothrombin time(PT),and two D-dimer was positive in 20 cases. All patients were treated with urokinase and anticoagulation therapy,including 2 cases with intraductal lower extremity venous thrombolytic therapy,both of them were successfully removed thrombosis,thrombolysis treatment in other 20 patients,and all of them were successful thrombolysis.Conclusion:Cesarean section,multiple complications,maternal bed time late is the important factor causing the perinatal of lower extremity deep venous thrombosis.Thrombolysis and thrombectomy operation is an important means of treatment of lower extremity deep venous thrombosis.%目的：探讨孕产妇围生期下肢深静脉血栓形成的临床特征，降低围生期下肢深静脉血栓的形成，降低孕产妇死亡率。方法：2011年2月-2014年4月收治孕产妇围生期下肢深静脉血栓形成患者22例，对其年龄、孕产史、发病时间、首发症状、发生部位等资料进行总结和分析。结果：发生在妊娠期7例，妊娠时间4～31周，平均12.2周；发生在产褥期15例，其中发生在剖宫产术后11例，发生在经阴道分娩后4例，发生时间产后3～40 d，平均25.1 d。发生在左下肢19例，发生在右下肢3例。发生的静脉部位：发生在胫后静脉1例，发生在大隐静脉2例，发生在腘静脉2例，发生在股静脉2例，发生在髂外静脉15例。患肢肿胀、疼痛、压痛，有不同程度的发热症状。孕产妇在剖宫产或经阴道分娩后卧床时间＞3 d 12例，合并症情况：产后出血11例，合并子痫前期4例，双胎2例，复发性流产7例，22例患者均经彩色多普勒确诊。辅助检查：少数患者活化凝血活酶时间(APTT)、凝血酶原时间(PT)异常，D-二聚体阳性20例。所有患者均经尿激酶抗凝治疗，其中2例采取导管内下肢静脉溶栓治疗，均成功取出血栓，其他20例患者经溶栓治疗，均成功溶栓。结论：剖宫产、合并症多、产妇下床时间晚是导致孕产妇围生期下肢深静脉血栓形成的重要因素，溶栓治疗和手术取栓是治疗下肢深静脉血栓的重要手段。