彩色多普勒超声对围产期静脉栓塞的预测价值
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摘要
目的 探讨彩色多普勒超声诊断对高危孕妇围产期静脉血栓的预测价值。方法 选择2017年1至12月在中国人民解放军第一一七医院进行围产期超声诊断并分娩的孕妇255例,其中血栓高危孕妇141例(A组),健康孕妇114例(B组),比较两组下肢静脉内径、血流频谱峰值及同期血液学指标。结果 A组双侧股总静脉内径均大于B组,双侧腘静脉内径均小于B组,组间比较差异有统计学意义(t值分别为4.286、3.995、5.713、4.657,均P<0.05),而双侧胫后静脉内径组间比较差异均无统计学意义(t值分别为2.038、2.661,均P>0.05);A组双侧腘静脉血流频谱峰值均小于B组,组间比较差异有统计学意义(t值分别为5.667、3.956,均P<0.05),而双侧股总静脉血流频谱峰值组间均无明显差异(t值分别为1.674、2.087,均P>0.05),两组血小板、血红蛋白、凝血酶原时间、D-二聚体、红细胞比容、纤维蛋白原组间比较差异均无统计学意义(t值分别为0.682、0.995、1.327、1.264、0.589、1.267,均P>0.05)。结论 围产期彩色多普勒超声能有效发现下肢深静脉血流瘀滞,表现为血管内径显著增宽,血流频谱峰值降低,提示其在血栓预防和诊断方面有一定的应用价值。
Objective To explore the predictive value of color Doppler ultrasound diagnosis in perinatal venous thrombosis in high-risk pregnant women. Methods A total of 255 pregnant women who accepted perinatal ultrasound diagnosis and gave birth to a child in Chinese People's Liberation Army No. 117 Hospital during January to December 2017 were selected, including 141 pregnant women at high risk of thrombosis(group A) and 114 healthy pregnant women(group B). The venous internal diameter of lower limb, peak value of blood flow spectrum and hematological parameters during corresponding period were compared between two groups. Results The internal diameters of bilateral femoral veins in group A were larger than those in group B, while for the bilateral popliteal vein, the internal diameters in group A were smaller than those in group B. There was significant difference between two groups(t value was 4.286, 3.995, 5.713 and 4.657, respectively, both P<0.05). There was no significant difference between two groups in internal diameter of bilateral posterior tibial vein(t value was 2.038 and 2.661, respectively, both P>0.05). The peak value of blood flow spectrum of bilateral popliteal vein in group A was lower than that in group B(t value was 5.667 and 3.956, respectively, both P<0.05), but there was no significant difference between two groups in peak value of bilateral femoral venous blood flow spectrum(t value was 1.674 and 2.087, respectively, both P>0.05). There was no significant difference in platelet, hemoglobin, prothrombin time, D dimer, erythrocyte specific volume and fibrinogen between two groups(t value was 0.682, 0.995, 1.327, 1.264, 0.589 and 1.267, respectively, all P>0.05). Conclusion Perinatal color Doppler ultrasonography can effectively detect deep venous blood stasis in lower limb, which shows that the significantly widened diameter of blood vessel and reduced peak value of blood flow spectrum, suggesting that it has certain application value in the prevention and diagnosis of thrombosis.
Objective To explore the predictive value of color Doppler ultrasound diagnosis in perinatal venous thrombosis in high-risk pregnant women. Methods A total of 255 pregnant women who accepted perinatal ultrasound diagnosis and gave birth to a child in Chinese People's Liberation Army No. 117 Hospital during January to December 2017 were selected, including 141 pregnant women at high risk of thrombosis(group A) and 114 healthy pregnant women(group B). The venous internal diameter of lower limb, peak value of blood flow spectrum and hematological parameters during corresponding period were compared between two groups. Results The internal diameters of bilateral femoral veins in group A were larger than those in group B, while for the bilateral popliteal vein, the internal diameters in group A were smaller than those in group B. There was significant difference between two groups(t value was 4.286, 3.995, 5.713 and 4.657, respectively, both P<0.05). There was no significant difference between two groups in internal diameter of bilateral posterior tibial vein(t value was 2.038 and 2.661, respectively, both P>0.05). The peak value of blood flow spectrum of bilateral popliteal vein in group A was lower than that in group B(t value was 5.667 and 3.956, respectively, both P<0.05), but there was no significant difference between two groups in peak value of bilateral femoral venous blood flow spectrum(t value was 1.674 and 2.087, respectively, both P>0.05). There was no significant difference in platelet, hemoglobin, prothrombin time, D dimer, erythrocyte specific volume and fibrinogen between two groups(t value was 0.682, 0.995, 1.327, 1.264, 0.589 and 1.267, respectively, all P>0.05). Conclusion Perinatal color Doppler ultrasonography can effectively detect deep venous blood stasis in lower limb, which shows that the significantly widened diameter of blood vessel and reduced peak value of blood flow spectrum, suggesting that it has certain application value in the prevention and diagnosis of thrombosis.
引文
[1]Hara N,Miyamoto T,Yamaguchi J,et al.Treatment outcomes of anticoagulant therapy and temporary inferior vena cava filter implantation for pregnancy complicated by venous thrombosis[J].Ann Vasc Dis,2018,11(1):106-111.
[2]Konishi H,Miyoshi T,Neki R,et al.Intrapartum temporary inferior vena cava filters are rarely indicated in pregnant women with deep venous thromboses[J].J Vasc Surg Venous Lymphat Disord,2015,3(4):370-375.
[3]Giacchetti L,De Gaudenzi M,Leoncini A,et al.Neonatal renal and inferior vena cava thrombosis associated with fetal thrombotic vasculopathy:a case report[J].J Med Case Rep,2017,11(1):248.
[4]Dumantepe M,Tarhan I A,Yurdakul I,et al.Ultrasound-accelerated catheter-directed thrombolysis for the management of postpartum deep venous thrombosis[J].J Obstet Gynaecol Res,2013,39(5):1065-1069.
[5]Gedikoglu M,Oguzkurt L.Endovascular treatment of iliofemoral deep vein thrombosis in pregnancy using US-guided percutaneous aspiration thrombectomy[J].Diagn Interv Radiol,2017,23(1):71-76.
[6]王晓燕,王秀.围生期孕产妇下肢深静脉血栓的临床特征、预后及影响因素分析[J].中国计划生育和妇产科,2016,8(9):28-31.
[7]许雪如,魏冬梅,薛海琴,等.穴位按摩联合低分子肝素注射治疗妇科术后下肢深静脉血栓的效果[J].中国计划生育和妇产科,2015,(7):37-40.
[8]Dueppers P,Grabitz K,Li Y,et al.Surgical management of iliofemoral vein thrombosis during pregnancy and the puerperium[J].J Vasc Surg Venous Lymphat Disord,2016,4(4):392-399.
[9]Rodger M A,Phillips P,Kahn S R,et al.Low-molecular-weight heparin to prevent postpartum venous thromboembolism:a pilot randomised placebo-controlled trial[J].Thromb Haemost,2015,113(1):212-216.
[10]Bannow B T S,Skeith L.Diagnosis and management of postpartum ovarian vein thrombosis[J].Hematology Am Soc Hematol Educ Program,2017,2017(1):168-171.
[11]Li C,Gong Y,Dong L,et al.Is prophylactic tranexamic acid administration effective and safe for postpartum hemorrhage prevention?A systematic review and meta-analysis[J].Medicine (Baltimore),2017,96(1):e5653.
[12]Gedikoglu M,Oguzkurt L.Endovascular treatment of iliofemoral deep vein thrombosis in pregnancy using US-guided percutaneous aspiration thrombectomy[J].Diagn Interv Radiol,2017,23(1):71-76.
[13]Bennett A,Chunilal S.Diagnosis and management of deep vein thrombosis and pulmonary embolism in pregnancy[J].Semin Thromb Hemost,2016,42(7):760-773.
[14]Sangüesa Nebot C,Llorens Salvador R,Picó Aliaga S,et al.Perinatal testicular torsion:ultrasound assessment and differential diagnosis[J].Radiologia,2017,59(5):391-400.
[15]Dueppers P,Grabitz K,Li Y,et al.Surgical management of iliofemoral vein thrombosis during pregnancy and the puerperium[J].J Vasc Surg Venous Lymphat Disord,2016,4(4):392-399.
[16]陶芳,骆骏.低分子肝素钠联合间歇充气装置预防剖宫产术后深静脉血栓[J].中国计划生育和妇产科,2015,(3):57-59.
[17]Giussani D A.The fetal brain sparing response to hypoxia:physiological mechanisms[J].J Physiol,2016,594(5):1215-1230.
[18]Furue A,Mochizuki J,Onishi Y,et al.Ultrasonic findings of fetal axillary lymphangioma with intralesional hemorrhage[J].J Med Ultrason (2001),2016,43(2):285-289.
[19]Zhang D,Zhang J,Gan Q,et al.Validating the psychometric characteristics of the perinatal posttraumatic stress disorder questionnaire(PPQ) in a Chinese context[J].Arch Psychiatr Nurs,2018,32(1):57-61.
[20]胡海燕,张静芳,张美,等.经会阴超声对围产期耻骨联合分离的诊断价值[J].中国妇幼健康研究,2017,28(8):979-981.
[21]Tiralongo G M,Lo Presti D,Pisani I,et al.Assessment of total vascular resistance and total body water in normotensive women during the first trimester of pregnancy.A key for the prevention of preeclampsia[J].Pregnancy Hypertens,2015,5(2):193-197.
[2]Konishi H,Miyoshi T,Neki R,et al.Intrapartum temporary inferior vena cava filters are rarely indicated in pregnant women with deep venous thromboses[J].J Vasc Surg Venous Lymphat Disord,2015,3(4):370-375.
[3]Giacchetti L,De Gaudenzi M,Leoncini A,et al.Neonatal renal and inferior vena cava thrombosis associated with fetal thrombotic vasculopathy:a case report[J].J Med Case Rep,2017,11(1):248.
[4]Dumantepe M,Tarhan I A,Yurdakul I,et al.Ultrasound-accelerated catheter-directed thrombolysis for the management of postpartum deep venous thrombosis[J].J Obstet Gynaecol Res,2013,39(5):1065-1069.
[5]Gedikoglu M,Oguzkurt L.Endovascular treatment of iliofemoral deep vein thrombosis in pregnancy using US-guided percutaneous aspiration thrombectomy[J].Diagn Interv Radiol,2017,23(1):71-76.
[6]王晓燕,王秀.围生期孕产妇下肢深静脉血栓的临床特征、预后及影响因素分析[J].中国计划生育和妇产科,2016,8(9):28-31.
[7]许雪如,魏冬梅,薛海琴,等.穴位按摩联合低分子肝素注射治疗妇科术后下肢深静脉血栓的效果[J].中国计划生育和妇产科,2015,(7):37-40.
[8]Dueppers P,Grabitz K,Li Y,et al.Surgical management of iliofemoral vein thrombosis during pregnancy and the puerperium[J].J Vasc Surg Venous Lymphat Disord,2016,4(4):392-399.
[9]Rodger M A,Phillips P,Kahn S R,et al.Low-molecular-weight heparin to prevent postpartum venous thromboembolism:a pilot randomised placebo-controlled trial[J].Thromb Haemost,2015,113(1):212-216.
[10]Bannow B T S,Skeith L.Diagnosis and management of postpartum ovarian vein thrombosis[J].Hematology Am Soc Hematol Educ Program,2017,2017(1):168-171.
[11]Li C,Gong Y,Dong L,et al.Is prophylactic tranexamic acid administration effective and safe for postpartum hemorrhage prevention?A systematic review and meta-analysis[J].Medicine (Baltimore),2017,96(1):e5653.
[12]Gedikoglu M,Oguzkurt L.Endovascular treatment of iliofemoral deep vein thrombosis in pregnancy using US-guided percutaneous aspiration thrombectomy[J].Diagn Interv Radiol,2017,23(1):71-76.
[13]Bennett A,Chunilal S.Diagnosis and management of deep vein thrombosis and pulmonary embolism in pregnancy[J].Semin Thromb Hemost,2016,42(7):760-773.
[14]Sangüesa Nebot C,Llorens Salvador R,Picó Aliaga S,et al.Perinatal testicular torsion:ultrasound assessment and differential diagnosis[J].Radiologia,2017,59(5):391-400.
[15]Dueppers P,Grabitz K,Li Y,et al.Surgical management of iliofemoral vein thrombosis during pregnancy and the puerperium[J].J Vasc Surg Venous Lymphat Disord,2016,4(4):392-399.
[16]陶芳,骆骏.低分子肝素钠联合间歇充气装置预防剖宫产术后深静脉血栓[J].中国计划生育和妇产科,2015,(3):57-59.
[17]Giussani D A.The fetal brain sparing response to hypoxia:physiological mechanisms[J].J Physiol,2016,594(5):1215-1230.
[18]Furue A,Mochizuki J,Onishi Y,et al.Ultrasonic findings of fetal axillary lymphangioma with intralesional hemorrhage[J].J Med Ultrason (2001),2016,43(2):285-289.
[19]Zhang D,Zhang J,Gan Q,et al.Validating the psychometric characteristics of the perinatal posttraumatic stress disorder questionnaire(PPQ) in a Chinese context[J].Arch Psychiatr Nurs,2018,32(1):57-61.
[20]胡海燕,张静芳,张美,等.经会阴超声对围产期耻骨联合分离的诊断价值[J].中国妇幼健康研究,2017,28(8):979-981.
[21]Tiralongo G M,Lo Presti D,Pisani I,et al.Assessment of total vascular resistance and total body water in normotensive women during the first trimester of pregnancy.A key for the prevention of preeclampsia[J].Pregnancy Hypertens,2015,5(2):193-197.