J Thromb Haemost:妊娠期间和产后严重肺栓塞的治疗选择!

2017-08-19 xing.T MedSci原创

由此可见,发表的在妊娠期和产后采用溶栓治疗的严重PE病例显示具有较高的母体和胎儿存活率(分别为94%和88%)。在产后,由于溶栓治疗所致的大出血高风险,应考虑其他治疗方案(导管或手术取栓,ECMO等)。

妊娠期或产后期大量肺栓塞(PE)是一种罕见但严重的事件。血栓和凝血疾病权威杂志Journal of Thrombosis and Haemostasis上发表了一篇荟萃分析文章,研究人员旨在系统地评价证据以指导其治疗。

研究人员通过计算机检索了PubMed、EMBASE、学术会议和RIETE注册中心以检索已发表的关于在怀孕期间或在分娩6周内发生的、并采用重度溶栓治疗、经皮穿刺或手术取栓和/或ECMO治疗的严重(次大面积/块状)PE病例。分析的主要结局为孕产妇存活以及大出血、早产、胎儿存活和出血。

研究人员发现了127例采用至少一种方法治疗的重症PE(至少83%为块状,23%发生心跳骤停)患者。在83例接受溶栓治疗的患者中,其存活率为94%(95%可信区间为86-98%)。在怀孕期间大出血的风险为17.5%,产后为53.9%,并且主要是严重的产后出血所致。在怀孕期间有12%的病例发生胎儿死亡,可能与PE或治疗有关。在36例接受手术取栓的患者中,母亲的生存和大出血的风险分别为86.1%(95%可信区间为71-95)和20%,可能与手术相关的胎儿死亡为20%。约半数的严重产后PE发生在分娩后24h内。

由此可见,发表的在妊娠期和产后采用溶栓治疗的严重PE病例显示具有较高的母体和胎儿存活率(分别为94%和88%)。在产后,由于溶栓治疗所致的大出血高风险,应考虑其他治疗方案(导管或手术取栓,ECMO等)。

原始出处:

G Martillotti,et al. Treatment options for severe pulmonary embolism during pregnancy and the postpartum period: a systematic review.Journal of Thrombosis and Haemostasis.2017. http://onlinelibrary.wiley.com/doi/10.1111/jth.13802/full

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    2018-06-26 changfy
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    2017-08-20 清风拂面

    谢谢分享,学习了

    0

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    2017-08-20 130****4638

    学习了谢谢分享

    0

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