2012—2018年扬州市妇幼保健院产后静脉血栓的分析

Analysis of postpartum venous thrombosis in Yangzhou Maternal and Child Gare Service Centre from 2012 to 2018

目的探讨产后静脉血栓的发生率、危险因素、发生时间、临床表现及诊断,避免过渡治疗。方法对2012年1月—2018年12月扬州大学附属医院扬州市妇幼保健院(以下简称“我院”)收治47948名孕产妇中5例产后发生静脉血栓者的临床资料进行回顾性分析。按2015年4月英国皇家妇产科医师学会发布了关于降低妊娠期及产褥期静脉血栓栓塞疾病发生风险的诊疗指南中标准进行评分,并且比较患者分娩前、血栓发现时凝血功能的差异。同时与我院2018年晚期妊娠无并发症及合并症的正常孕妇6525名的分娩前凝血功能进行比较。结果5例患者均经综合性医院及我院彩色多普勒超声或CT肺动脉造影确诊,深静脉血栓3例,浅静脉血栓2例,深静脉血栓中1例肺栓塞。近6年发生率为(1.04~1.07)/万。5例患者均发生在产后1周内,5例患者中1例危险因素评分为4分,1例患者危险因素评分为3分,3例患者危险因素评分为1分。有下肢疼痛症状患者4例。5例患者分娩前、血栓发现时凝血功能比较,差异无统计学意义(P>0.05),但与6525名正常孕妇的分娩前凝血功能比较,5例患者分娩前凝血酶原时间、凝血酶时间短于正常孕妇(P<0.05),活化部分凝血酶原时间、国际标准化比值、纤维蛋白原、D-二聚体比较,差异无统计学意义(P>0.05)。经抗凝治疗,5例患者均痊愈。结论产后静脉血栓发病率低,分娩前PT、TT明显缩短及分娩后出现下肢疼痛症状,警惕静脉血栓的发生,一旦发生及早治疗。

Objective To investigate the incidence,risk factors,occurrence time,clinical manifestations and diagnosis of postpartum venous thrombosis,and to avoid overtreatment.Methods The clinical data of five cases of postpartum venous thrombosis in 47948 pregnant women admitted to Yangzhou Maternal and Child Care Service Centre(hereinafter referred to as“our hospital”)from January 2012 to December 2018 were retrospectively analyzed.The score according to the criteria set out in the April 2015 Royal College of Obstetricians and Gynaecologists guidelines on reducing the risk of venous thromboembolism during pregnancy and puerperium,the differences in clotting function before delivery and at the time of thrombus discovery were compared.Meanwhile,the coagulation function was compared with that of 6525 normal pregnant women without complications and complications in the third trimester pregnancy in our hospital in 2018.Results All five cases were confirmed by color doppler ultrasonography or CT pulmonary angiography in general hospitals and our hospital,including three cases of deep vein thrombosis,two cases of superficial vein thrombosis,and one case of deep vein thrombosis.In recent six years,the incidence was(1.04-1.07)/10000.All of the five cases occurred within one week after delivery.Among the five patients,one case had a risk factor score of four,one case had a risk factor score of three,and three cases had a risk factor score of one.Four cases had lower extremity pain symptoms.Comparison of coagulation function between the five patients before delivery and at the time of thrombosis discovery showed no statistically significant difference (P > 0.05). However, compared with the coagulation function before delivery of 6525 normal pregnant women, the prothrombin time (PT) and thrombin time (TT) of five cases before delivery were shorter than that of normal pregnant women (P < 0.05). There were no significant differences in activated partial prothrombin time, international standardized ratio, fibrinogen and D-dimer (P > 0.05). After anticoagulant therapy, all the five cases recovered. Conclusion The incidence of postpartum venous thrombosis is low, PT and TT before delivery are shortened significantly and lower limb pain symptoms appear after delivery.