妊娠并发静脉血栓栓塞症影响因素分析  

Analysis of Influencing Factors of Venous Thromboembolism in Pregnancy

作　　者：吴婕[1] 刘珺[1] 张燕[1] 冯幸子[1] 陆秦楠 董旭东[1] WU Jie;LIU Jun;ZHANG Yan;FENG Xing-zi;LU Qin-nan;DONG Xu-dong(Department of Obstetrics,the First People's Hospital of Yunnan Province the Affiliated Hospital of Kunming University of Science and Technology,Kunming 650032,China)

机构地区：[1]云南省第一人民医院昆明理工大学附属医院产科,昆明650032

出　　处：《临床误诊误治》2022年第10期87-91,共5页Clinical Misdiagnosis & Mistherapy

基　　金：云南省科技厅-昆明医科大学应用基础研究(202101AY070001-264);云南省科技厅-昆明医科大学应用基础研究(202101AY070001-242)。

摘　　要：目的探讨妊娠并发静脉血栓栓塞症(VTE)的相关影响因素。方法选取2016年1月-2020年12月收治的妊娠并发VTE孕产妇168例作为研究组,同期住院分娩排除VTE孕产妇672例作为对照组。收集2组临床资料,采用单因素和多因素Logistic回归分析筛选妊娠并发VTE的影响因素。结果妊娠并发VTE 168例中发生于孕早期和孕中期各1例,孕晚期9例,产褥期157例;肺栓塞(PE)92例,下肢深静脉血栓(DVT)99例,PE合并DVT 23例。妊娠并发PE患者主要临床表现为低氧血症20例,胸闷12例,呼吸困难9例;D-二聚体升高42例。妊娠并发DVT主要临床表现为下肢疼痛22例,下肢酸胀和下肢无力各1例。多因素Logistic回归分析结果显示,阴道分娩是妊娠并发VTE的保护因素(P<0.01),产后出血≥1000 ml、子痫前期、产褥感染、产后肠梗阻和下肢静脉曲张是妊娠并发VTE的危险因素(P<0.05,P<0.01)。结论产后出血≥1000 ml、子痫前期、产褥感染、产后肠梗阻和下肢静脉曲张为妊娠并发VTE的危险因素,对上述危险因素进行筛查、干预和治疗,有利于降低孕产妇VTE发病率和病死率。Objective To discuss the influencing factors of venous thrombotic disease(VTE)during in pregnancy Methods From January 2016 to December 2020,168 pregnant or puerperium women who were diagnosed with VTE were selected as the case group,and 672 non VTE patients were selected as control group.The clinical data of case-control group were collected,and Chisquare test andMultivariate logistic regression were used to analyze the risk factors of VTE in pregnant women.Results In 168 cases of pregnancy complicated with VTE,1 case occurred in the first trimester,1 case occurred in the second trimester,9 cases occurred in the third trimester and 157 cases in the puerperium.There were 92 cases of pulmonary embolism,99 cases ofdeep vein thrombosis and 23 cases ofpulmonary embolism combined with deep vein thrombosis.The main clinical manifestations of pregnancy complicated with PE were hypoxemia in 20 cases,chest tightness in 12 cases,and dyspnea in 9 cases;D-dimer increased in 42 cases.The main clinical manifestations of pregnancy complicated with DVT were lower limb pain in 22 cases,lower limb distension in 1 case and lower limb weakness in 1 case.Logistic multivariate analysis showed that vaginal delivery was the protective factor of VTE(P<0.01),postpartum hemorrhage≥1000 ml,puerperal infection,postpartum intestinal obstruction,preeclampsia,varicose veins were the main influence factors for VTE(P<0.05,P<0.01).Conclusion This study found that postpartum hemorrhage≥1000 ml,puerperal infection,preeclampsia and postpartum intestinal obstruction were risk factors for the occurrence of VTE.Screening,intervention and treatment of these risk factors of VTE can reduce the morbidity and mortality of pregnant women.

关 键 词：静脉血栓栓塞症 妊娠并发症 阴道分娩 产后出血 子痫前期 感染 肠梗阻 

分 类 号：R714.25[医药卫生—妇产科学] R543[医药卫生—临床医学]