Gerbasi F R, Bottoms S, Farag A, Mammen E F
Department of Anesthesiology, Wayne State University, Hutzel Hospital, Detroit, MI 48201.
Am J Obstet Gynecol. 1990 May;162(5):1158-63. doi: 10.1016/0002-9378(90)90006-s.
Postpartum deep vein thrombosis is believed to be related to increased activation of the hemostasis system at the time of delivery. To date, studies designed to test this hypothesis have had relatively small sample sizes or used the measurement of specific coagulation factors and functional tests reflecting hemostasis activity in vitro. With the use of recent technologic advances we determined the effect of delivery on hemostasis in vivo by measuring 11 hemostatic indices simultaneously in 70 healthy pregnant women. Significant increases were found in fibrinopeptide A (p less than 0.001), beta-thromboglobulin (p less than 0.001), and platelet factor 4 (p less than 0.001), suggesting maximum platelet activation and fibrin formation at the time of delivery. In addition to continued clotting activity at 3 hours post partum, increased D-dimer, fibrin-fibrinogen degradation products, and decreased alpha 2-antiplasmin levels suggest maximum fibrinolysis. These changes reflect a peak in hemostatic activity at delivery and in the immediate postpartum period that may predispose the development of deep vein thrombosis.
产后深静脉血栓形成被认为与分娩时止血系统激活增加有关。迄今为止，旨在验证这一假设的研究样本量相对较小，或采用了特定凝血因子的测定以及反映体外止血活性的功能测试。利用最近的技术进展，我们通过同时测量70名健康孕妇的11项止血指标，确定了分娩对体内止血的影响。发现纤维蛋白肽A（p<0.001）、β-血小板球蛋白（p<0.001）和血小板因子4（p<0.001）显著增加，提示分娩时血小板最大程度激活和纤维蛋白形成。除产后3小时凝血活性持续存在外，D-二聚体、纤维蛋白-纤维蛋白原降解产物增加以及α2-抗纤溶酶水平降低提示纤维蛋白溶解达到最大程度。这些变化反映了分娩时和产后即刻止血活性达到峰值，这可能易引发深静脉血栓形成。
