Engelmann L, Ruckhäberle K E, Engelmann B, Scheel H, Vogtmann C, Deckert F
Abteilung für Intensivmedizin, Universität Leipzig.
Z Gesamte Inn Med. 1993 Apr;48(4):190-6.
This is a case report on a course of gemini-pregnancy complicated by gestosis, recurrent submassive pulmonary embolism and discordant growth of the hypotrophic twins. It is concluded from this report that: 1. the AT-III-deficiency in gestosis can be caused by loss and consumption; 2. due to decrease below a critical AT-III-level the coagulation-fibrinolysis system tends to decompensate, reflected in a disseminated intravascular coagulation and/or a pulmonary embolism. The tendency consists particularly in immobilisation and stasis; 3. the daily determination of AT III, better of TAT-complex and D-dimer, the daily clinical examination regarding signs of thrombosis and in cases of heparinization the measurement of PTT several times daily, are necessary to avoid or recognise disorders, of the coagulation-fibrinolysis-system at an early stage. 4. The increased consumption in coagulation systems can be avoided by AT-III substitution and correct heparinisation. 5. In cases of risk of pulmonary embolisation in pregnancy a cava filter should be temporarily implanted. The filter must be changed every 3 days, if it is required for a longer period. 6. In high-risk pregnancy the check for factors of thrombophilia is a basic diagnostic procedure.
这是一篇关于双胎妊娠合并妊娠中毒症、复发性次大面积肺栓塞及生长不一致的低体重双胎病例报告。从本报告得出以下结论：1. 妊娠中毒症中的抗凝血酶III（AT-III）缺乏可能由丢失和消耗引起；2. 由于AT-III水平降至临界值以下，凝血-纤溶系统趋于失代偿，表现为弥散性血管内凝血和/或肺栓塞。这种倾向尤其在于制动和血流淤滞；3. 为了早期避免或识别凝血-纤溶系统紊乱，每日测定AT III，更好是测定凝血酶-抗凝血酶复合物（TAT复合物）和D-二聚体，每日进行关于血栓形成体征的临床检查，以及在肝素化情况下每日多次测定部分凝血活酶时间（PTT）是必要的。4. 通过AT-III替代和正确的肝素化可避免凝血系统消耗增加。5. 在妊娠有肺栓塞风险的情况下，应临时植入下腔静脉滤器。如果需要较长时间使用，该滤器必须每3天更换一次。6. 在高危妊娠中，检查血栓形成倾向因素是一项基本诊断程序。
