Clinical Analysis Of Pulmonary Thromboembolism During Puerperal Period

Objective:To explore the risk factors of pulmonary thromboembolism(PTE)during puerperal period,and to analyze the clinical symptoms,signs,laboratory test results,imaging examination,treatment methods and prognosis,so as to provide constructive guidance for future clinical diagnosis and treatment.Methods:Clinical data of 19 patients with PTE during puerperal period admitted to the First Affiliated Hospital of Kunming Medical University from January 1,2015 to December 31,2019 and 62 randomly selected patients without PTE during puerperal period in the control group were collected.A regression statistical analysis was conducted on the clinical data,which were divided into case group and control group according to the occurrence of PTE during puerperal period.The clinical data included the following:(1)General conditions:age,number of pregnancies,body mass index(BMI),natural conception,regular prenatal examination,gestational weeks,length of stay and weight gain during pregnancy.(2)Comparison of complications of pregnancy included:advanced age,obesity and preeclampsia.(3)Delivery mode and postpartum status:premature delivery,emergency cesarean section,postpartum hemorrhage,postpartum blood transfusion,transfer of puerpera to ICU and transfer of neonates to pediatrics;(4)Relevant data of patients with PTE during puerperal period:time of occurrence of PTE,clinical manifestations and signs,consultation of respiratory department and related departments,complications and complications of PTE,laboratory examination and imaging examination;(5)Treatment plan:dose,frequency and time of use of low molecular weight heparin(LMWH)and discharge treatment plan.The above data were analyzed to discover the risk factors for PTE during puerperal period,and to discuss the clinical characteristics,diagnosis methods and treatment options of puerperal PTE in pregnant and pregnant women.Results:(1)Comparison of genneral conditions:the mean age of the case group was higher than that of the control group(P<0.05).The average hospitalized days of case group were longerr than the control group(P<0.05).The delivery pregnancy weeks in the case group than was higher than in the control group(P<0.05).There were no significantly differences in emergency cesarean section,number of pregnancies,cases of assisted reproduction,BMI and gestational weight gain between the two group(P>0.05).(2)Analysis of risk factors:the incidence rate of advanced Age,BMI?30kg/m2,postpartum blood transfusion,preterm delivery and preeclampsia was was higher in the case group than in the control group(P<0.05).The risk of PTE during puerperal in patients with obesity(BMI?30kg/m2)and postpartum blood transfusion in the case group was 5.892(OR:5.892,95%CI:1.466-23.682)times and 7.970(OR:7.970,95%CI:1.616-39.308)times higher than in the control group(P<0.05).(3)Clinical symptoms and signs:the incidence of PTE occurred 3 days and 2 days after cesarean section was 42.1%and 31.6%.The most common admission symptoms were dyspnea(73.7%),chest tightness(42.1%)and cough(21.1%).Dry wet then sound(52.6%),sound of breath is rough(26.3%),Breath sounds low(15.8%),asthmatic breathing sounds(10.5%),no pulmonary signs(21.1%);Lower limbs swelling(47.4%);cyanosis of lips(26.3%).Vital signs:the average temperature was 37.81?,tachycardia(57.9%).The average of Blood oxygen saturation under deoxidizing conditions was 82.93%.(4)Auxiliary examination:the average of plasma d-dimer was 6.17±5.25ug/L,the average of B-type natriuretic peptide(BNP)was 308.48±202.69pg/ml.All the 19 patients were diagnosed by computed tomography Pulmonary angiography(CTPA):thromboembolism in the right lung(57.9%),thromboembolism in the left lung(26.7%)and thromboembolism in both lung(13.3%).Thromboembolism in the lower lobe of the lung(73.7%).Chest X-ray shows increased and blurred lung texture(63.2%).(5)Maternal treatment and outcome:all the patients improved after anticoagulation treatment,and there were no deaths.(6)Neonatal outcome:transferred to pediatrics(31.6%).Conclusion(s):(1)Obesity and postpartum blood transfusion will increase the risk of PTE during puerperal period.Advanced age,postpartum hemorrhage,preterm delivery and preeclampsia are risk factors for PTE during puerperal period.Reasonable weight gain during pregnancy and strict control of postpartum blood transfusion indications are important measures to prevent PTE during puerperal period.(2)The most common clinical symptom of PTE in puerperal period is dyspnea,followed by cough and chest pain,and fever is the main systemic symptom of PTE patients.(3)Plasma levels of d-dimer and BNP in patients with PTE during puerperal period were higher than normal.(4)Patients with PTE during puerperal period should receive standardized treatment,and patients with PTE with the assistance of multiple disciplines are conducive to the early detection and treatment of the disease.Patients at high blood risk were given anticoagulant therapy after a thorough assessment of their condition.