分娩方式与下肢深静脉血栓形成的相关性研究

Study of Relation Between Mode of Delivery and Postpartum Lower Extremity Deep Venous Thrombosis

目的分析分娩方式与产后下肢深静脉血栓形成(DVT)的关系并探讨其治疗方法。方法回顾性分析我院48例产后下肢DVT患者的临床资料。结果 2006年7月至2012年4月期间住院分娩总数15 897例,其中剖宫产10 097例(63.52%),发生下肢DVT 41例(0.41%);顺产5 800例(36.48%),发生下肢DVT 7例(0.12%)。剖宫产后下肢DVT发生率明显高于顺产(χ2=9.94,P<0.005)。每年的剖宫产例数和下肢DVT发生情况之间呈正相关(rs=0.87,P<0.05),即剖宫产率越高,下肢DVT发生率越高。48例下肢DVT患者均治愈出院,其中43例仅药物治疗,2例手术和药物结合治疗,3例采用气压梯度结合抗凝治疗,5例下腔静脉滤器置入结合药物治疗。结论剖宫产妇女下肢DVT的发生率较顺产者高,溶栓及抗凝疗法是治疗下肢DVT的有效方法,严格掌握剖宫产手术指征及产后尽早下床活动可减少DVT发生。

Objective To analyze the relation between the mode of delivery and postpartum lower extremity deep venous thrombosis （DVT）, and discuss the therapy methods. Methods The clinical data of 48 patients with post- partum lower extremity DVT from 2006 to 2012 in this hospital were analyzed retrospectively. Results There were 15 897 patients with the delivery, of whom were 10 097 cases of cesarean section and 5 800 cases of spontaneous delivery, the incidence rate of lower extremity DVT in the patients with cesarean section was significantly higher than that in the patients with spontaneous delivery [0. 41% （41/10 097） versus O. 12% （7/5 800）, X^2=9.94, P〈0. 005]. The higher incidence rate of cesarean section, the higher incidence rate of lower extremity DVT, which was a positive correlation between them （r5=0. 87, P〈 0. 05）. Forty-three cases were only treated by drug therapy, 2 cases were performed operation combined with drug therapy, and 5 cases were placed the inferior vena cava filter. Forty-eight cases were cured and discharged. Conclusions The incidence rate of lower extremity DVT of cesarean section is higher as compared with the spontaneous delivery. The thrombolysis and （or） anticoagulation therapy is an effective way in the treatment for DVT. Controlling indications of cesarean section and early postpartum out-of-bed can decrease the DVT.