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在怀孕期间严重肺栓塞的急性管理
Shahin Qadri1,2, Ashwini Bilagi1,2, Abha Sinha1
1Department of Obstetrics and Gynecology, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom.
怀孕期间的大规模肺栓塞 (PE) 是危险的. 血栓溶解在怀孕期间是有效的,但产后,血栓切除是首选的,以避免出血的风险.
科学领域:
- 产科和妇科 产科和妇科
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
背景情况:
- 怀孕和产后产生高凝血状态,增加大规模肺栓塞 (PE) 的风险.
- 在孕妇中诊断PE是具有挑战性的,因为生理变化和缺乏验证的评分系统.
- 在患有血液动力学不稳定的孕妇患者中,必须怀疑大量PE.
研究的目的:
- 审查在怀孕和产后大规模PE的病理生理学.
- 评估怀孕期间和产后大规模PE的治疗选择,包括它们的风险和益处.
- 突出了对孕妇和产后妇女PE诊断算法的需要.
主要方法:
- 关于怀孕和产后大规模肺栓塞的文献综述.
- 对治疗方式的分析,包括血栓溶解,血栓切除和ECMO.
- 评估与不同治疗相关的孕产妇和胎儿结局.
主要成果:
- 血栓溶解显示,在怀孕和产后大规模PE的孕妇 (94%) 和胎儿 (88%) 的生存率很高.
- 血栓溶解在分娩后期具有严重出血的高风险.
- 导管或手术性血栓切除术和ECMO是在分娩后的可行的替代方案.
结论:
- 血栓溶解是怀孕期间大量PE的成功治疗方法.
- 由于出血风险,应避免产后进行血栓溶解;血栓切除术是首选的治疗方法.
- 需要进一步的研究来开发在孕妇和产后人群中对PE的验证诊断算法.
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