目的 探讨心脏瓣膜置换术后孕妇适合的抗凝方案以及华法林对妊娠和分娩过程的影响.方法 回顾性分析经治的22例心脏瓣膜置换术后妊娠患者的临床表现、处理及结局.心脏机械瓣膜置换术后均采用口服华法林抗凝.其中12例(组1,华法林组)妊娠期继续口服低剂量(<5mg/d)华法林抗凝治疗,10例(组2,低分子肝素组)孕妇确诊早孕后即用低分子肝素皮下注射,至孕12周后恢复华法林口服抗凝治疗,至分娩前2周改用低分子肝素皮下注射剂,比较两组的妊娠结局.结果 22例心脏瓣膜置换术后妊娠患者经过合理抗凝,适时剖宫产分娩,无胎儿畸形发生.组1母体并发症2例(16.67%),与组2的1例(10.00%)比较无显著性差异(直接概率P=0.43).组1围产儿并发症2例(16.67%),与组2(0例)比较无显著性差异(直接概率P=0.29).两组新生儿出生体重比较有显著性差异(t=1.50,P<0.05).结论 妊娠期间口服华法林能有效防止血栓形成,未增加胎儿畸形等围产不良结局发生的风险.%Objective To investigate the proper anticoagulant therapy for pregnant women with cardiac valve replacement and the influence of warfarin on pregnancy and delivery. Methods The clinical manifestation, treatment and outcomes of 22 pregnant women after cardiac valve replacement were retrospectively analyzed. They were orally administrated with warfarin to prevent thrombosis before pregnancy. 12 cases ( Group 1, warfarin group ) continued to use warfarin( < 5mg/d ) during gestational period. The other 10 cases ( Group 2, Low Molecular Heparin group ) were administrated with low molecular heparin after diagnosed with pregnancy. After 12 weeks of gestation continued to orally administrate warfarin, and two weeks before birth low molecular heparin was used. The outcomes of pregnancy were compared between two groups. Results With proper anticoagulant therapy, 22 cases with cardiac valve replacement received caesarean section in time and no fetal anormaly existed. The difference in incidence of maternal complications between group 1 ( 2, 16.67％ ) and group 2 ( 1, 10.00％ ) was not significant ( direct probability P = 0.43 ), and the difference in incidence of perinatal complications between group 1 ( 2, 16.67％ ) and group 2 ( 0 ) was not significant ( direct probability P =0.29 ). But there was significant difference in birth weight between two groups ( t = 1.50, P < 0.05 ). Conclusion Administration of warfarin during pregnancy can effectively prevent thrombosis and does not increase the risk of adverse perinatal outcomes such as fetal malformation.
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