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目的探讨产褥期肺血栓栓塞症(PTE)的临床表现、辅助检查特征、治疗方法和临床转归。方法统计2006年1月-2011年11月广州医学院第一附属医院自然分娩产妇的例数和剖宫产术例数,以及其中PTE的发生情况。回顾性分析住院期间发生PTE的产妇病历资料。结果搜集研究期间分娩的产妇共5052例,其中行剖宫产术者2910例(57.6%),经阴道分娩2142例(42.4%)。5052例产妇住院期间,13例(0.26%)经CT肺血管造影确诊PTE,其中11例发生于产后3d内。剖宫产术较阴道分娩PTE发病率增加3.2倍(0.38%vs 0.09%,P=0.043)。PTE最常见症状是呼吸困难(76.9%)、咳嗽(53.8%)、胸痛(23.1%)、发热(30.8%)。经抗凝(11例)或溶栓治疗(2例),PTE症状显著改善,无死亡病例。结论 6年来本院产妇住院期间PTE发病率0.26%。对分娩,尤其是剖宫产3d内突然出现气促、胸闷、胸痛的产妇,应警惕产褥期PTE。
Objective To investigate the clinical manifestations, auxiliary examination features, treatment methods and clinical outcomes of puerperal pulmonary thromboembolism (PTE). Methods From January 2006 to November 2011, the number of cases of spontaneous labor and number of cesarean section in the First Affiliated Hospital of Guangzhou Medical College and the incidence of PTE among them were statistically analyzed. Retrospective analysis of maternal history data of PTE occurred during hospitalization. Results A total of 5,052 pregnant women were delivered during the study period, of which 2910 (57.6%) were cesarean and 2142 (42.4%) were delivered vaginally. During the 5052 maternal hospitalizations, 13 (0.26%) were confirmed by CT pulmonary angiography for PTE, of which 11 occurred within 3 days after delivery. The incidence of cesarean delivery was 3.2 times greater than that of vaginal delivery (0.38% vs 0.09%, P = 0.043). The most common symptoms of PTE were dyspnea (76.9%), cough (53.8%), chest pain (23.1%) and fever (30.8%). After anticoagulation (n = 11) or thrombolysis (n = 2), the symptoms of PTE were significantly improved with no deaths. Conclusion The incidence of PTE during hospitalization in our hospital during 6 years was 0.26%. On childbirth, especially cesarean section within a sudden onset of shortness of breath, chest tightness, chest pain in mothers, should be wary of puerperium PTE.