妊娠期血栓前状态孕妇凝血功能的变化分析_肖欢

2016年6月第37卷第3期

首都医科大学学报Journal of Capital Medical University

Jun.2016Vol.37No.3

基金项目：首都卫生发展科研专项（首发2014－4－7082），通州区卫生发展科研专项（twkyzx2014－07）。This study was supported by Special Fund

for the Development of Health Science in the Capital （Shoufa 2014－4－7082），Tongzhou District Special Fund for Health Development and Ｒesearch （twkyzx2014－07）．

*Corresponding author ，E-mail ：1963mawei@sina．com 网络出版时间：2016－06－0718ʒ39网络出版地址：http ：//www．cnki．net /kcms /detail /11．3662．r．20160607．1839．018．html

［doi ：10.3969/j．issn.1006-7795.2016.03.026］

·临床研究·

妊娠期血栓前状态孕妇凝血功能的变化分析

肖

欢

高

洁

金艳荣

马红梅

耿丽艳

李

蕊

田

丹

马

唯

*

（首都医科大学附属北京潞河医院妇产科，北京101149）【摘要】目的

探讨血栓前状态孕妇剖宫产术前后凝血指标的变化情况。方法

经超声诊断

“暴风雪征”66例妊娠期血栓前状态孕妇以及同期住院66例下肢静脉超声正常孕妇的活化的部分凝血活酶时间（activated partial thromboplastin time ，APTT ）、凝血酶原时间（prothrombin time ，PT ）、凝血酶时间（thrombin time ，TT ）、纤维蛋白原（fibrinogen ，FBG ）以及D-二聚体（D-dimer ，D-D ）进行相应的对比分析，初步探讨凝血相关指标的改变与血栓前状态发生的相关性。结果

血栓前状态组与正常妊娠组的PT 、

TT 、FBG 差异无统计学意义（P ＞0.05）。APTT 、D-D 在血栓前状态组分别为（30.79ʃ3.89）s 和（480.81ʃ189.75）ng /mL ，正常妊娠组分别为（32.44ʃ3.59）s 和（364.74ʃ81.76）ng /mL ，差异有统计学意义（P ＜0.05）。结论测定D －二聚体有利于协助诊

断妊娠期血栓前状态，对于明显升高者进一步行下肢静脉超声明确诊断。血栓前状态孕妇产后应监测D －二聚体及超声，及时

发现有无下肢深静脉血栓形成，避免严重致命性肺栓塞发生。【关键词】血栓前状态；下肢深静脉血栓形成；妊娠【中图分类号】Ｒ714.2

Analysis of changes of blood coagulation function in pregnant women with prethrombotic state

Xiao Huan ，Gao Jie ，Jin Yanrong ，Ma Hongmei ，Geng Liyan ，Li Ｒui ，Tian Dan ，Ma Wei *

（Department of Obstetrics and Gynecology ，Beijing Luhe Hospital ，Capital Medical University ，Beijing 101149，China ）

【Abstract 】Objective To investigate the changes of blood coagulation indexes before and after cesarean section in pregnant women with prethrombotic state．Methods Totally 66cases with prethrombotic state in the diagnosis of “snowstorm sign ”by ultrasound were enrolled ，compared with the same period hospitalized pregnant women in 66cases of normal lower limb venous ultrasound．The prothrombin time （PT ）and activated partial thromboplastin time （APTT ），thrombin time （TT ），fibrin original （FBG ）and D dimer （D-D ）in the two groups were compared to the corresponding analysis ，to study the correlation between coagulation related parameters change and prethrombotic state．Ｒesults There was no significant difference between the prethrombotic state group and normal pregnancy group in PT ，TT ，FBG （P ＞0.05）．APTT and D-D in the prethrombotic state was （30.79ʃ3.89）s and （480.81ʃ189.75）ng /mL ，which

have significant difference compared to （32.44ʃ3.59）s and （364.74ʃ81.76）ng /mL in the normal pregnancy group （P ＜0.05）．Conclusion The determination of D-D is helpful for the diagnosis of gestational prethrombotic state．It is necessary to further diagnosis by

lower limb venous ultrasound for the obviously increased cases．The prethrombotic state in pregnant women should be monitored for D dimer and ultrasound to disover whether the deep venous thrombosis of lower extremity was formed ，and avoid severe and fatal pulmonary embolism．

【Key words 】prethrombotic state ；deep venous thrombosis ；pregnancy

育龄妇女中，妊娠妇女较非妊娠妇女静脉血栓栓

塞性疾病（venous thromboembolism ，

VTE ）的发生率约高5倍，静脉血瘀滞的加重为最主要的危险因素。妊

娠期，孕妇所处的高凝状态、静脉血流缓慢以及分娩

或剖宫产术时对骨盆静脉的损伤共同组成了血栓形

成的Virchow

“三要素”［1］

。血栓前状态（prethrombotic state ，PS ）是高凝状态（hypercoagulative state ，HCS ）和

“血栓前期”等有血栓形成倾向的术语演变而来，其强