高龄产妇采用低分子肝素钙预防产后深静脉血栓的疗效与安全性探讨
摘要
目的探讨高龄产妇采用低分子肝素钙预防产后深静脉血栓的临床疗效与安全性。方法选取本院2012年6月至2016年6月300例剖宫产高龄产妇为研究对象,采用随机数字表法分为对照组(150例)和研究组(150例)。两组产后均予气压预防,研究组再予低分子肝素钙皮下注射预防。观察两组术后3 h与术后5 d血液流变学及凝血五项的水平,并统计住院期间深静脉血栓发生率及出血率。结果两组术后5d全血高切黏度、全血中切黏度、全血低切黏度、血浆黏度低于同组术后3 h,红细胞变形指数高于同组术后3 h(P<0.05)。术后5 d,研究组全血高切黏度、全血中切黏度、全血低切黏度、血浆黏度低于同期对照组,红细胞变形指数高于同期对照组,两组间差异有统计学意义(P<0.05)。对照组凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)、血小板计数(PLT)水平在术后3 h与术后5 d组内差异无统计学意义(P>0.05);研究组术后5 d FIB、D-D水平低于同组术后3 h(P<0.05)。术后5 d研究组FIB、D-D水平低于同期对照组(P<0.05)。对照组产后深静脉血栓16例(10.7%),研究组2例(1.3%),组间差异有统计学意义(P<0.01)。对照组无一例出血,研究组共出血3例(2.0%),组间差异无统计学意义(P>0.05)。结论剖宫产高龄产妇产后3 h血液黏度高,低分子肝素钙可有效降低血液黏度、FIB及D-D水平,减少产后深静脉血栓发生率,无明显增加出血风险。
引文
[1]Woods L,Perez-Garcia V,Kieckbusch J,et al.Decidualisation and placentation defects are a major cause of age-related reproductive decline[J].Nat Commun,2017,8(1):352.DOI:10.1038/s41467-017-00308-x.
[2]Fayed AA,Wahabi H,Mamdouh H,et al.Demographic profile and pregnancy outcomes of adolescents and older mothers in SaudiArabia:analysis from Riyadh Mother(RAHMA)and Baby cohort study[J].BMJ Open,2017,7(9):e016501.DOI:10.1136/bmjopen-2017-016501.
[3]Pomp ER,Lenselink AM,Rosendaal FR,et al.Pregnancy,the postpartum period and prothrombotic defects:risk of venous thrombosis in the MEGA study[J].J Thromb Haemost,2008,6(4):632-637.DOI:10.1111/j.1538-7836.2008.02921.x.
[4]潘晓冬,冉德森.彩超对上肢静脉血栓的诊断价值探讨[J].首都医药,2007,(20):30.DOI:10.3969/j.issn.1005-8257.2007.20.019.
[5]田丹,李蕊,许琳妍,等.高危孕产妇下肢深静脉血栓形成的预防和护理[J].中国病案,2017,18(7):108-112.DOI:10.3969/j.issn.1672-2566.2017.07.038.
[6]Kodama J,Seki N,Masahiro S,et al.D-dimer level as a risk factor for postoperative venous thromboembolism in Japanese women with gynecologic cancer[J].Ann Oncol,2010,21(8):1651-1656.DOI:10.1093/annonc/mdq012.
[7]孙艳,郭凤婵.妊娠期静脉血栓栓塞的研究现状[J].国外医学(妇产科学分册),2004,31(1):19-21.DOI:10.3969/j.issn.1674-1870.2004.01.007.
[8]Crowley MP,Noone C,Higgins JR,et al.A Multicentre Study of Thromboprophylaxis in Pregnancy[J].Ir Med J,2017,110(5):567.
[9]Shen MC,Wu WJ,Cheng PJ,et al.Low-molecular-weight-heparin can benefit women with recurrent pregnancy loss and sole protein S deficiency:a historical control cohort study from Taiwan[J].Thromb J,2016,14:44.DOI:10.1186/s12959-016-0118-9.
[10]Tzafettas J,Mamopoulos A,Anapliotis A,et al.Thromboprophylaxis throughout pregnancy in women with previous history of recurrent miscarriages of unknown aetiology[J].Clin Exp Obstet Gynecol,2002,29(4):267-270.
[11]Villani M,Ageno W,Grandone E,et al.The prevention and treatment of venous thromboembolism in pregnancy[J].Expert Rev Cardiovasc Ther,2017,15(5):397-402.DOI:10.1080/14779072.2017.1319279.
[2]Fayed AA,Wahabi H,Mamdouh H,et al.Demographic profile and pregnancy outcomes of adolescents and older mothers in SaudiArabia:analysis from Riyadh Mother(RAHMA)and Baby cohort study[J].BMJ Open,2017,7(9):e016501.DOI:10.1136/bmjopen-2017-016501.
[3]Pomp ER,Lenselink AM,Rosendaal FR,et al.Pregnancy,the postpartum period and prothrombotic defects:risk of venous thrombosis in the MEGA study[J].J Thromb Haemost,2008,6(4):632-637.DOI:10.1111/j.1538-7836.2008.02921.x.
[4]潘晓冬,冉德森.彩超对上肢静脉血栓的诊断价值探讨[J].首都医药,2007,(20):30.DOI:10.3969/j.issn.1005-8257.2007.20.019.
[5]田丹,李蕊,许琳妍,等.高危孕产妇下肢深静脉血栓形成的预防和护理[J].中国病案,2017,18(7):108-112.DOI:10.3969/j.issn.1672-2566.2017.07.038.
[6]Kodama J,Seki N,Masahiro S,et al.D-dimer level as a risk factor for postoperative venous thromboembolism in Japanese women with gynecologic cancer[J].Ann Oncol,2010,21(8):1651-1656.DOI:10.1093/annonc/mdq012.
[7]孙艳,郭凤婵.妊娠期静脉血栓栓塞的研究现状[J].国外医学(妇产科学分册),2004,31(1):19-21.DOI:10.3969/j.issn.1674-1870.2004.01.007.
[8]Crowley MP,Noone C,Higgins JR,et al.A Multicentre Study of Thromboprophylaxis in Pregnancy[J].Ir Med J,2017,110(5):567.
[9]Shen MC,Wu WJ,Cheng PJ,et al.Low-molecular-weight-heparin can benefit women with recurrent pregnancy loss and sole protein S deficiency:a historical control cohort study from Taiwan[J].Thromb J,2016,14:44.DOI:10.1186/s12959-016-0118-9.
[10]Tzafettas J,Mamopoulos A,Anapliotis A,et al.Thromboprophylaxis throughout pregnancy in women with previous history of recurrent miscarriages of unknown aetiology[J].Clin Exp Obstet Gynecol,2002,29(4):267-270.
[11]Villani M,Ageno W,Grandone E,et al.The prevention and treatment of venous thromboembolism in pregnancy[J].Expert Rev Cardiovasc Ther,2017,15(5):397-402.DOI:10.1080/14779072.2017.1319279.