摘要
目的探讨剖宫产术后肺栓塞的临床特点、临床诊断、高危因素、预防、治疗方法及预后。方法回顾性分析2020年1月至2021年9月在北京大学深圳医院剖宫产术后出现肺栓塞的7例患者的病例资料。结果剖宫产肺栓塞的发生率为0.20%(7/3421),阴道分娩为0%(0/3528),差异有统计学意义(P<0.05)。7例肺栓塞均发生在剖宫术后7 d内,6例(6/7,85.71%)患者术后需予低分子肝素标准预防,实际进行低分子肝素标准预防2例(33.33%)。主要临床表现为:呼吸困难或气促5例(71.43%),胸闷4例(57.14%),血氧饱和度降低(≤94%)7例(100%)。肺动脉造影CT检查显示1例肺动脉干及其大分支栓塞,6例为肺叶动脉栓塞。肺栓塞合并下肢静脉血栓1例(剖宫产术前已存在)。心脏彩超检查提示4例(57.14%)存在肺动脉高压(35~52 mmHg)。7例患者的NT-B型钠尿肽及D-二聚体明显升高,7例患者的白蛋白低于正常值。诊断后进行多学科诊治,1例患者行介入造影+血栓抽栓及选择性溶栓+腔静脉滤器放置术,其余6例予低分子肝素抗凝治疗。经治疗,7例患者均痊愈出院。病例1在术后3个月复查肺CT血管造影(CT angiography,CTA)显示血栓消失,行滤网取出术。病例3~5在发病7~14 d复查CTA显示血栓消失。其余3例半年内复查CTA提示血栓消失。结论剖宫产术是肺栓塞的高危因素,剖宫产术后1周是高危时期,血清白蛋白水平降低有可能增加肺栓塞的风险。B型钠尿肽及D-二聚体有助于肺栓塞的诊断。术后及时行高危因素评分及采取合适的预防措施是预防肺栓塞的有效方法。
Objective To investigate the clinical features,diagnosis,high-risk factors,prevention,treatment and prognosis of pulmonary embolism after cesarean section.Methods 7 patients with pulmonary embolism after cesarean section in Peking University Shenzhen Hospital from January 2020 to September 2021 were analyzed retrospectively.Results The incidence of pulmonary embolism after cesarean section was 0.20%(7/3421),and vaginal delivery was 0%(0/3528),and the difference was statistically significant(P<0.05).7 cases of pulmonary embolism occurred within 7 days after cesarean section.After cesarean section,low molecular weight heparin was needed in 6 cases(6/7,85.71%).In fact,drug standard prevention was used in 2 cases(2/6,33.33%).The main clinical manifestations were:dyspnea or shortness of breath in 5 cases(71.43%),chest tightness in 4 cases(57.14%),and decreased blood oxygen saturation(≤94%)in 7 cases(100%).Pulmonary angiography CT examination showed 1 case of pulmonary artery trunk and its large branches embolism,6 cases of pulmonary artery embolism.Pulmonary embolism combined with deep vein thrombosis in 1 case(existing before cesarean section).Cardiac ultrasonography showed that 4 cases(57.14%)had pulmonary hypertension(35~52 mmHg).The NT-B-type natriuretic peptide and D-dimer were significantly elevated in 7 patients,and the albumin in 7 patients was lower than normal.After diagnosis,multidisciplinary diagnosis and treatment were performed.One patient underwent interventional angiography+thrombectomy and selective thrombolysis+vena cava filter placement,and the remaining 6 patients were treated with low molecular weight heparin anticoagulation.All 7 patients were cured and discharged after treatment.In case 1,pulmonary CT angiography(CTA)showed that the thrombus disappeared 3 months after the operation,and the filter was removed.In cases 3~5,the re-examination of CTA at 7~14 days after the onset showed that the thrombus disappeared.The remaining 3 cases were reexamined within half a year and the thrombus disappeared.Conclusion Cesarean section is a high-risk factor for pulmonary embolism,and 1 week after cesarean section is a high-risk period,and a decrease in serum albumin level may increase the risk of pulmonary embolism.B-type natriuretic peptide and D-dimer are helpful in the diagnosis of pulmonary embolism.Timely scoring of high risk factors and taking appropriate preventive measures after surgery are effective methods to prevent pulmonary embolism.
作者
梁轶珩
黄春华
Liang Yiheng;Huang Chunhua(Department of Obstetrics and Gynecology,Peking University Shenzhen Hosipital,Shenzhen Guangdong 518036,P.R.China)
出处
《中国计划生育和妇产科》
2022年第10期68-72,共5页
Chinese Journal of Family Planning & Gynecotokology
关键词
肺栓塞
剖宫产
妊娠
临产特点
pulmonary embolisms
cesarean section
pregnancy
clinic characteristics
作者简介
通信作者:梁轶珩,毕业于北京大学医学部,博士,副主任医师,主要研究方向为产科急危重症的救治及研究,E-mail:liangyiheng.cn@163.com。
