| 姚铖聪,王婷婷,李和江.孕产妇急性肺栓塞五例并文献分析[J].浙江中西医结合杂志,2023,33(1): |
| 孕产妇急性肺栓塞五例并文献分析 |
| Acute pulmonary embolism in pregnant women: report of 5 cases and literature analysis |
| 投稿时间：2022-06-21 修订日期：2022-10-14 |
| DOI： |
| 中文关键词: 肺栓塞 CT肺动脉造影 D-二聚体 抗凝治疗 |
| 英文关键词:Pulmonary embolism Computed tomographic pulmonary angiography D- dimer Anticoagulation therapy |
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| 中文摘要: |
| 【摘要】目的 探讨孕产妇急性肺栓塞的诊疗特点。 方法 回顾性分析了2018年1月至2022年5月浙江大学医学院附属杭州市第一人民医院收治的5例孕产妇急性肺栓塞患者的临床资料，并结合中国知网、万方数据库等进行文献检索，总结分析孕产妇急性肺栓塞的诊疗特点。 结果:（1）早发临床表现：2例患者的早发临床表现为“胸闷”，2例为“胸痛”，1例为“血氧饱和度降低伴发头痛、抽搐及意识丧失”；（2）诊断：5例患者血D-二聚体变化差异大，均通过电子计算机断层扫描（computed tomography,CT)肺动脉造影确诊肺栓塞；（3）治疗：5例患者确诊肺栓塞后使用肝素及利伐沙班（或华法林）规范抗凝治疗，1例患者在剖宫产术前行经皮下腔静脉滤器置入术，5例患者的D-二聚体在规范治疗后均呈现下降趋势；（4）预后：5例患者预后良好，1例孕早期患者行医疗性流产，其余4例患者未出现围产儿死亡。 结论 发生急性肺栓塞的孕产妇临床表现各异，应积极行CT肺动脉造影明确诊断，血D-二聚体变化趋势可作为肺栓塞抗凝治疗的疗效评价指标,及时的规范治疗可降低死亡率，改善预后。 |
| 英文摘要: |
| 【Abstract】Purpose To explore the diagnosis and treatment characteristics of acute pulmonary embolism in pregnant women. Methods Analyzing 5 cases of maternal patients with acute pulmonary embolism between January 2018 and May 2022 were admitted to Affiliated Hangzhou First People’s Hospital,Zhejiang University School of Medicine,summarizing the diagnosis and treatment characteristics of acute pulmonary embolism in pregnant women based on literature conducted on CNKI and Wanfang data. Results (1)Early clinical manifestation: "chest tightness" in 2 patients as early clinical manifestations, "chest pain" in 2 patients，"decreased oxygen saturation accompanied by headache, convulsions and loss of consciousness" in 1 patient;(2)Diagnosis:The changes of D- dimer in blood of 5 patients were significant,they were diagnosed as Pulmonary embolism by computed tomographic pulmonary angiography;(3)Treatment:5 patients received standard anticoagulation therapy with heparin and rivaroxaban (or warfarin),1 patient underwent subcutaneous vena cava filter before cesarean section.The D- dimer of 5 patients showed a downward trend after standard treatment;(4)Prognosis: The prognosis of 5 patients was good,1 patient in early pregnancy had a medical abortion, the other 4 patients had no perinatal deaths. Conclusion The clinical manifestations of acute pulmonary embolism in pregnant women are different，computed tomographic pulmonary angiography should be performed actively to confirm the diagnosis,the trend of D- dimer can be used as an index to evaluate the curative effect of anticoagulant therapy.Timely and standardized treatment can reduce mortality and improve prognosis. |
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