機械瓣置換術后妊娠婦女妊娠期間全程服用華法林對兒童體格及智力發育的影響初探_《中國循證醫學雜志》

作者：

蔣露 ¹ , 楊凡 ² , 李永波 ¹ , 朱喜亮 ¹ ,  肖錫俊 ¹

1. 四川大學華西醫院胸心外科（成都 610041）；2. 四川大學華西婦產兒童醫院兒童保健科（成都 610041）;

關鍵詞：

機械瓣置換術妊娠華法林兒童體格發育智力發育

DOI：

10.7507/1672-2531.20120082

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目的　探討機械瓣置換術后妊娠婦女妊娠期間全程服用華法林抗凝治療對其生育兒童體格及智力發育的影響。
方法　將12名機械瓣置換術后的妊娠婦女所生育的兒童作為研究對象（試驗組），分別進行體格及智力測定。測定指標包括：① 體格發育指標：身高、體重、坐高、頭圍、胸圍；② 智力發育指標：智商和發育商。發育商適用于評估0～3歲（0～36月）年齡階段兒童的智力發育情況。發育商指標包括：適應性、大運動、精細運動、語言、個人-社會。智商適用于評估4歲及4歲以上兒童的智力發育情況。按照試驗組與對照組1∶2配對的方法選取正常婦女生育的24名兒童作為對照組，比較兩組各項指標之間的差異。
結果　機械瓣置換術后妊娠婦女生育的兒童與正常婦女生育的兒童在0～3歲、4～6歲和6～12歲三個年齡階段的體格發育指標及智力發育指標的差異均無統計學意義（P gt;0.05）。
結論　機械瓣置換術后的妊娠婦女妊娠期全程口服華法林抗凝治療在每日服藥劑量≤?5 mg的情況下，未觀察到其對兒童的體格及智力發育有負面影響。

引用本文： 蔣露,楊凡,李永波,朱喜亮,肖錫俊. 機械瓣置換術后妊娠婦女妊娠期間全程服用華法林對兒童體格及智力發育的影響初探. 中國循證醫學雜志, 2012, 12(5): 516-519. doi: 10.7507/1672-2531.20120082 復制

1.	Hall JG, Pauli RM, Wilson K. Maternal and fetal sequelae of anticoagulant during pregnancy. Am J Med, 1980, 68(1): 122-140.
2.	Stevenson RE, Burton M, Ferlauto GJ, et al. Hazards of oral anticoagulants during pregnancy. JAMA, 1980, 243(15): 1549-1551.
3.	Wesseling J, Van Driel D, Heymans HS, et al. Coumarins during pregnancy: long-term effects on growth and development of school-age children. Thromb Haemost, 2001, 85(4): 609-613.
4.	Bonnar J. Hemostasis and coagulation disorders in pregnancy. In: Bloom AL, Thomas DP, editors. Haemostasis and Thrombosis. London: Churchill Livingstone, 1994: 570-583.
5.	Suri V, Keepanasseril A, Aqqarwal N, et al. Mechanical valve prosthesis and anticoagulation regimens in pregnancy: a tertiary centre experience. Eur J Obstet Gynecol Reprod Biol, 2011, 159(2): 320-323.
6.	Jeejeebhoy FM. Prosthetic heart valves and management during pregnancy. Can Fam Physician, 2009, 55(2): 155-157.
7.	Chan WS, Anand S, Ginsberg JS. Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med, 2000, 160(2): 191-196.
8.	McLintock C. Anticoagulation therapy in pregnant women with mechanical prosthetic heart valves: no easy option. Thromb Res, 2011, 127 Suppl 3: S56-S60.
9.	Kawamata K, Neki R, Yamanaka K, et al. Risk and pregnancy outcome in women with prosthetic mechanical heart valve replacement. Circ J, 2007, 71(2): 211-213.
10.	邊策. 李濤, 劉興會. 心臟瓣膜置換術后華法林抗凝治療圍產結局的影響. 現代婦產科進展, 2008, 17(9): 690-692.
11.	Van Driel D, Wesseling J, Rosendaal FR, et al. Growth until puberty after in utero exposure to coumarins. Am J Genet, 2000, 95(5): 438-443.
12.	Vitale N, De Feo M, De Santo LS, et al. Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol, 1999, 33(6): 1637-1641.
13.	Vahanian A, Baumgartner H, Bax J, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J, 2007, 28(2): 230-268.
14.	Hung L, Rahimtoola SH. Prosthetic heart valves and pregnancy. Circulation, 2003, 107(9): 1240-1246.

1. Hall JG, Pauli RM, Wilson K. Maternal and fetal sequelae of anticoagulant during pregnancy. Am J Med, 1980, 68(1): 122-140.
2. Stevenson RE, Burton M, Ferlauto GJ, et al. Hazards of oral anticoagulants during pregnancy. JAMA, 1980, 243(15): 1549-1551.
3. Wesseling J, Van Driel D, Heymans HS, et al. Coumarins during pregnancy: long-term effects on growth and development of school-age children. Thromb Haemost, 2001, 85(4): 609-613.
4. Bonnar J. Hemostasis and coagulation disorders in pregnancy. In: Bloom AL, Thomas DP, editors. Haemostasis and Thrombosis. London: Churchill Livingstone, 1994: 570-583.
5. Suri V, Keepanasseril A, Aqqarwal N, et al. Mechanical valve prosthesis and anticoagulation regimens in pregnancy: a tertiary centre experience. Eur J Obstet Gynecol Reprod Biol, 2011, 159(2): 320-323.
6. Jeejeebhoy FM. Prosthetic heart valves and management during pregnancy. Can Fam Physician, 2009, 55(2): 155-157.
7. Chan WS, Anand S, Ginsberg JS. Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med, 2000, 160(2): 191-196.
8. McLintock C. Anticoagulation therapy in pregnant women with mechanical prosthetic heart valves: no easy option. Thromb Res, 2011, 127 Suppl 3: S56-S60.
9. Kawamata K, Neki R, Yamanaka K, et al. Risk and pregnancy outcome in women with prosthetic mechanical heart valve replacement. Circ J, 2007, 71(2): 211-213.
10. 邊策. 李濤, 劉興會. 心臟瓣膜置換術后華法林抗凝治療圍產結局的影響. 現代婦產科進展, 2008, 17(9): 690-692.
11. Van Driel D, Wesseling J, Rosendaal FR, et al. Growth until puberty after in utero exposure to coumarins. Am J Genet, 2000, 95(5): 438-443.
12. Vitale N, De Feo M, De Santo LS, et al. Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol, 1999, 33(6): 1637-1641.
13. Vahanian A, Baumgartner H, Bax J, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J, 2007, 28(2): 230-268.
14. Hung L, Rahimtoola SH. Prosthetic heart valves and pregnancy. Circulation, 2003, 107(9): 1240-1246.

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機械瓣置換術后妊娠婦女妊娠期間全程服用華法林對兒童體格及智力發育的影響初探

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機械瓣置換術后妊娠婦女妊娠期間全程服用華法林對兒童體格及智力發育的影響初探

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