产褥期静脉血栓栓塞症防治的临床研究
1. 云南省第一人民医院/昆明理工大学附属医院, 产科, 云南昆明 650034
2. 恒台县妇幼保健院, 产科, 山东淄博 256499
| 摘 要： | 目的：分析产褥期静脉血栓栓塞症（venous thromboembolism, VTE）的危险因素以及血清学标志物与血栓发生的相关性，为该病的早期诊断及防治提供科学依据。方法：对2020年1月至2021年12月在云南省第一人民医院分娩后确诊血栓的108例孕产妇和抽取同期分娩且孕周相同的产妇540例进行研究，统计分析VTE的危险因素和VTE与血清学标志物的相关性。结果：产次（≥3次）、产后出血、妊娠合并症、围产期手术、肠梗阻以及风湿免疫系统是产褥期血栓形成的危险因素。在血栓组与正常组血清学标志物比较中，NLP、RDW、FDP、FIB、ATⅢ和D-二聚体差异有统计学意义（p＜0.05）。结论：在产褥期根据VTE评分表积极地预防性抗凝治疗，同时关注血清学标志物的变化，对孕产妇VTE的早期识别和干预有重要意义。 |
| 关 键 词： | 产褥期; 静脉血栓栓塞症; 肺栓塞; 深静脉血栓形成; 危险因素 |
| DOI： | 10.57237/j.wjcm.2023.02.001 |
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收稿日期: 2023-03-19
接受日期: 2023-04-20
在线出版日期: 2023-04-25
Clinical Study on Prevention and Treatment of Venous Thrombosis in Puerperium
1. Department of Obstetrics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650034, China
2. Department of Obstetrics, The Maternal and Child Health Hospital of Hengtai County, Zibo 256499, China
| Abstract: | Objective: To analyze the risk factors of venous thromboembolism and the correlation between serum markers and thrombosis, so as to provide scientific basis for the early diagnosis, prevention and treatment of the disease. Methods: A total of 108 pregnant women diagnosed with thrombosis after delivery in the First People's Hospital of Yunnan Province from January 2020 to December 2021 and 540 pregnant women with the same gestational age who delivered in the same period were selected for the study. The risk factors of VTE and the correlation between VTE and serological markers were statistically analyzed. Results: The risk factors of venous thrombosis include parity (≥3 times), postpartum hemorrhage, pregnancy complications, perinatal surgery, intestinal obstruction and rheumatic immune system. There were significant differences in NLP, RDW, FDP, FIB, ATⅢ and D-dimer between the thrombosis group and the normal group (P＜0.05). Conclusions: Prophylactic anticoagulant therapy was actively performed during puerperal period according to the VTE rating scale, and at the same time pay attention to the changes of serum markers, which is of significance for early identification and intervention of VTE in pregnant women. |
| Keywords: | Puerperium; Venous Thromboembolism; Pulmonary Embolism; Deep Venous Thrombosis; Risk Factors |
基金
| 1. | 云南省妇产疾病临床医学研究中心项目 (2022YJZX-FC18) |
参考文献
| [1] | 中华医学会妇产科学分会产科学组, 杨慧霞, 王子莲, 等. 妊娠期及产褥期静脉血栓栓塞症预防和诊治专家共识 [J]. 中华妇产科杂志, 2021, 56 (4): 236-243. |
| [2] | Meng K, Hu X, Peng X, Zhang Z. Incidence of venous thromboembolism during pregnancy and the puerperium: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2015; 28 (3): 245-253. |
| [3] | 张凌, 段涛. 126例孕产妇静脉血栓栓塞症危险因素分析 [J]. 国际妇产科学杂志, 2022, 49 (2): 141-146. |
| [4] | Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014; 2 (6): e323-e333. |
| [5] | Le Gal G, Kercret G, Ben Yahmed K, et al. Diagnostic value of single complete compression ultrasonography in pregnant and postpartum women with suspected deep vein thrombosis: prospective study. BMJ. 2012; 344: e2635. |
| [6] | Revel MP, Cohen S, Sanchez O, et al. Pulmonary embolism during pregnancy: diagnosis with lung scintigraphy or CT angiography?. Radiology. 2011; 258 (2): 590-598. |
| [7] | 徐冬, 蔡淑萍, 徐静薇, 等. 孕期及产褥早期妇女血浆D-二聚体水平的变化 [J]. 中华妇产科杂志, 2016 (9): 666-671. |
| [8] | Budnik I, Brill A. Immune Factors in Deep Vein Thrombosis Initiation [J]. Trends in Immunology, 2018, 39 (8). |
| [9] | Rezende S M, Lijfering W M, Rosendaal F R, et al. Hematologic variables and venous thrombosis: red cell distribution width and blood monocyte count are associated with an increased risk [J]. Haematologica, 2014, 99 (1): 194-200. |
| [10] | Ercan, zkan, Sadullah, N Yücel, et al. Establishing reference intervals for D-dimer to trimesters [J]. Journal of Maternal-Fetal Medicine, 2015, 28 (8): 983-987. |
| [11] | Greer I A. Thrombosis in pregnancy: updates in diagnosis and management. [J]. Hematology, 2012 (1): 203-207. |
| [12] | 黄宏伟. 临产孕妇凝血指标检测的临床意义 [J]. 中国民康医学, 2016, 28 (022): 48-49. |
| [13] | Sun W H, Yi K D, Yang M S, et al. Pregnancy-Induced Hypertension, But Not Gestational Diabetes Mellitus, Is a Risk Factor for Venous Thromboembolism in Pregnancy [J]. Korean Circulation Journal, 2011, 41 (1): 23-27. |
| [14] | Goldhaber S Z. Risk Factors for Venous Thromboembolism [J]. Archives of Internal Medicine, 2010, 56 (1): 1-7. |
| [15] | Sultan A A, Tata L J, West J, et al. Risk factors for first venous thromboembolism around pregnancy: a population-based cohort study from the United Kingdom. [J]. Blood, 2013, 121 (19): 3953-3961. |
| [16] | 上海市母婴安全专家委员会, 上海市医学会围产医学专科分会, 上海市医学会妇产科专科分会产科学组, 等. 上海市产科静脉血栓栓塞症防治的专家共识 [J]. 上海医学, 2020, 43 (11): 645-650. |
| [17] | Lim W. Using low molecular weight heparin in special patient populations. J Thromb Thrombolysis. 2010; 29 (2): 233-240. |
| [18] | Kane E V, Calderwood C, Dobbie R, et al. A population-based study of venous thrombosis in pregnancy in Scotland 1980–2005 [J]. European Journal of Obstetrics Gynecology & Reproductive Biology, 2013, 169 (2): 223-229. |
| [19] | Meng K, Hu X, Peng X, et al. Incidence of venous thromboembolism during pregnancy and the puerperium: a systematic review and meta-analysis [J]. Journal of Maternal-Fetal Medicine, 2015, 28 (3): 245-253. |
| [20] | Huang D, Wong E, Zuo M L, et al. Risk of venous thromboembolism in Chinese pregnant women: Hong Kong venous thromboembolism study [J]. Blood research, 2019, 54 (3). |
