Department of Surgery, Johns Hopkins Hospital, Baltimore, Md.
Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, Baltimore, Md.
J Vasc Surg Venous Lymphat Disord. 2018 Mar;6(2):246-255. doi: 10.1016/j.jvsv.2017.08.001. Epub 2017 Sep 21.
Pregnancy has significant effects on the lower extremity venous system. Increasing venous pressure and blood volume, in combination with reduced flow rates within the deep veins, predisposes pregnant women to both primary and secondary chronic venous insufficiency (CVI). This review article highlights the specific physiologic and hemodynamic changes that occur during pregnancy and examines the nonpharmacologic, pharmacologic, and invasive interventions that are appropriate for both prophylaxis and treatment of CVI and venous thromboembolism (VTE).
This study is a review article of the key literature related to VTE and CVI in pregnancy.
Significant hemodynamic changes occur in the lower extremities during pregnancy. Although well documented and essential to fetal development, these changes can have a negative impact on the maternal lower extremity venous circulation. Consequences of pregnancy can result in venous disease only during pregnancy or, particularly in the multiparous patient, can progress to CVI. An abundance of literature and guidelines exist for the management of VTE during pregnancy; however, the quality and extent of literature based around the management of primary CVI during pregnancy are modest at best.
The physiologic changes throughout the arterial and venous systems during pregnancy are well documented. However, there is a paucity of data available to construct guidelines for care, particularly in the pregnant patient with symptomatic superficial venous insufficiency. Further investigation in the form of prospective randomized trials is required to establish appropriate guidelines for treatment.
妊娠对下肢静脉系统有显著影响。静脉压和血容量增加，再加上深静脉内血流速度降低，使孕妇易患原发性和继发性慢性静脉功能不全（CVI）。本文综述了妊娠期间发生的特定生理和血液动力学变化，并探讨了适用于 CVI 和静脉血栓栓塞症（VTE）预防和治疗的非药物、药物和侵入性干预措施。
这是一篇关于妊娠期间 VTE 和 CVI 的关键文献的综述文章。
妊娠期间下肢会发生显著的血液动力学变化。尽管这些变化对胎儿发育至关重要且有充分记录，但它们可能对产妇下肢静脉循环产生负面影响。妊娠的后果可能仅在妊娠期间导致静脉疾病，或者在多产妇中，可能进展为 CVI。有大量文献和指南可用于妊娠期间 VTE 的管理；然而，基于妊娠期间原发性 CVI 管理的文献的质量和范围充其量只是适度的。
妊娠期间整个动脉和静脉系统的生理变化都有充分记录。然而，目前可用的数据很少，无法制定护理指南，特别是在有症状的浅静脉功能不全的妊娠患者中。需要进一步以前瞻性随机试验的形式进行调查，以制定适当的治疗指南。
