不同评估体系妊娠期及产褥期静脉血栓栓塞症评估及预防的差异  

Differences of different evaluation systems in the assessment and prevention of venous thromboembolism during pregnancy and puerperal period

作　　者：危玲[1] 祁少锷 陈奕[1] Wei Ling;Qi Shaoe;Chen Yi(Department of Obstetrics,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026;Department of Information,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026)

机构地区：[1]首都医科大学附属北京妇产医院产科,北京100026 [2]首都医科大学附属北京妇产医院信息科,北京100026

出　　处：《现代妇产科进展》2024年第10期747-751,共5页Progress in Obstetrics and Gynecology

基　　金：首都特色临床应用研究(No:Z181100001718091)。

摘　　要：目的:比较2015年英国皇家妇产科医师学会(RCOG)《妊娠期及产褥期静脉血栓栓塞症(VTE)诊治指南》、2021年中国《妊娠期及产褥期静脉血栓栓塞症预防和诊治专家共识》及北京妇产医院评估体系对妊娠期及产褥期静脉血栓栓塞症评估及预防的差异。方法:参考2015年RCOG妊娠期及产褥期VTE诊治指南建立我院产科VTE风险评估及预防策略,对2018年11月1日至2021年9月30日在我院产二科七病区产检并分娩的3277例患者进行VTE风险评估及管理。分别利用RCOG指南及中国共识推荐的VTE风险评估方案对患者进行评估,比较3种评估方案及预防标准的差异。结果:本院评估体系为参考RCOG指南风险评估,制定本院改良标准进行预防,3277例患者中20例(0.61%)在妊娠期使用了药物预防,VTE高危因素前三名依次为高龄(大于35岁)684例,辅助生殖受孕251例,BMI≥30kg/m^(2)129例;148例(占比4.51%)患者在产褥期使用了药物预防,VTE高危因素前三依次为择期剖宫产874例,高龄(大于35岁)703例,BMI≥30kg/m^(2)563例。按RCOG指南标准进行评估,妊娠期及产褥期需行VTE药物预防者分别为87例(2.65%)和1102例(33.6%)。按中国专家共识评估,妊娠期及产褥期需行VTE药物预防者分别为21例(0.64%)和795例(24.3%)。3277例孕产妇中,共发生2例VTE,其中1例发生在妊娠期,1例发生在产褥期,发病率0.6‰,均为下肢深静脉血栓,无肺栓塞发生;2例VTE患者按RCOG指南及中国专家共识分别进行评估,均无需药物预防。结论:与RCOG指南相比,应用中国VTE专家共识及我院VTE评估体系在妊娠期及产褥期进行VTE风险评估,可降低药物预防的比率,同时并未增加VTE发病率。Objective:To compare the differences between 2015 guideline“Reducing the risk of thrombosis and embolism during pregnancy and the puerperium”of the Royal College of Obstetricians and Gynaecologists(RCOG),the expert consensus on the prevention and treatment of venous thromboembolism(VTE)during pregnancy and the puerperium of China in 2021,and the evaluation system of Beijing Obstetrics and Gynecology Hospital in the assessment and prevention during pregnancy and the puerperium.Method:According to the 2015 RCOG guideline,the risk assessment and prevention strategy of obstetric VTE in our hospital were established,and the risk assessment and management of VTE were performed on 3277 patients who were examined and delivered in the seventh ward of the second Department of Obstetrics in our hospital from November 1,2018 to September 30,2021.Subsequently,the RCOG guidelines and China's consensus recommended VTE risk assessment protocols were used to evaluate these patients,and the differences among the three evaluation protocols and prevention criteria were compared.Result:The evaluation system of our hospital was based on the risk assessment of RCOG guidelines and the improvement standards of our hospital were formulated for prevention.Among the 3277 patients,20 patients(0.61%)used pharmaceutical prophylaxis during pregnancy.The top three risk factors for VTE were 684 patients with old age(over 35 years old)and 251 patients with assisted reproduction.BMI≥30kg/m^(2)129 cases.There were 148 patients(4.51%)in the puerperal period using drug prevention.The top three risk factors for VTE were elective cesarean section in 874 cases,elderly(over 35 years old)in 703 cases,and BMI≥30kg/m^(2)563 cases.All these patients were evaluated according to RCOG guidelines,87 cases(2.65%)needed VTE pharmaceutical prophylaxis during pregnancy and 1102 cases(33.6%)needed VTE pharmaceutical prophylaxis during the puerperium.According to the consensus assessment of Chinese experts,21 cases(0.64%)of VTE pharmaceutical prophylaxis were r

关 键 词：静脉血栓栓塞症 药物预防 评估体系 差异 

分 类 号：R714.7[医药卫生—妇产科学]