国际妇产科学杂志 ›› 2018, Vol. 45 ›› Issue (3): 263-266.

• 综述 • 上一篇    下一篇

心脏机械瓣膜置换术后妊娠期女性抗凝选择的研究进展

崔金帅,林浩,张小鹏,高秉仁   

  1. 730030  兰州大学第二临床医学院(崔金帅,林浩,张小鹏,高秉仁);兰州大学第二医院心脏外1科(高秉仁)
  • 收稿日期:2018-02-27 修回日期:2018-05-01 出版日期:2018-06-15 发布日期:2018-06-22
  • 通讯作者: 高秉仁,E-mail: bingrengao@sina.com E-mail:bingrengao@sina.com
  • 基金资助:
    兰州大学博士生导师科研基金项目(bdkyjj-08)

The Anticoagulation Regimen in Pregnant Women with Mechanical Prosthetic Heart Valves

CUI Jin-shuai, LIN Hao, ZHANG Xiao-peng, GAO Bing-ren   

  1. Lanzhou University Second Hospital, Lanzhou 730030, China (CUI Jin-shuai, LIN Hao, ZHANG Xiao-peng, GAO Bing-ren); Department 1 of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China (GAO Bing-ren)
  • Received:2018-02-27 Revised:2018-05-01 Published:2018-06-15 Online:2018-06-22
  • Contact: GAO Bing-ren, E-mail: bingrengao@sina.com E-mail:bingrengao@sina.com

摘要: 随着心脏外科事业的长足进步,越来越多的心脏瓣膜疾病患者可以通过心脏瓣膜置换术来改善心脏功能、提高生活质量。但是心脏机械瓣膜置换术后需终身抗凝治疗,在妊娠期女性中表现尤为重要。心脏机械瓣膜置换术后合并妊娠属高危妊娠范畴,目前对其管理缺乏统一性,一般强调个体化治疗。心脏机械瓣膜置换术后妊娠期的抗凝问题是充满争议的。华法林可以很好地预防妊娠期母体血栓的形成,但是华法林可以穿过胎盘影响胎儿的发育;肝素不能通过胎盘影响胎儿发育,但在监测方便度及预防血栓形成方面表现不佳;而对抗血小板药物和新型药物的使用尚未有更深入的研究。现就近年来抗凝药物的选择以及母胎结局加以综述,以期更好地服务于临床。

关键词: 心脏瓣膜假体植入, 妊娠, 孕妇, 华法林, 抗凝药, 肝素

Abstract: With the rapid development of cardiac surgery, more and more patients with heart valve disease can improve cardiac function and life quality through heart valve replacement. However, life-long anticoagulant therapy is required after mechanical heart valve replacement, and it is particularly important during pregnancy. Although mechanical heart valve replacement is associated with high-risk pregnancies, there is a lack of uniformity in the management of cardiac mechanical valve replacement. Individualized treatment is generally emphasizes. Anticoagulation during pregnancy after mechanical heart valve replacement is controversial. Warfarin can prevent the formation of maternal thrombus during pregnancy, but warfarin can affect the development of the fetus through the placenta. Heparin can not affect the development of the fetus through the placenta, but poorly monitor the convenience and prevent thrombosis. The anti-platelet drugs and the use of new drugs have not been further study. We reviews the choice of anticoagulants and maternal fetal outcomes in recent years in order to better serve the clinic.

Key words:  Heart valve prosthesis implantation, Pregnancy, Pregnant women, Warfarin, Anticoagulants, Heparin