中国九家医院孕产妇静脉血栓栓塞症的发病现状及危险因素调查

Survey of related factors of maternal venous thromboembolism in nine hospitals of China

目的调查分析我国妊娠期及产褥期静脉血栓栓塞症(VTE)的发病现状及危险因素。方法收集2015年1月1日至2019年11月30日中国9家医院诊断为妊娠期或产褥期VTE孕产妇的临床资料575例,回顾性分析VTE的发病现状及危险因素。结果(1)妊娠期及产褥期VTE的发病占比分别为50.6%(291/575)及49.4%(284/575)。4例死亡,死亡率为0.7%(4/575),死亡原因均为肺栓塞。(2)妊娠期及产褥期VTE的发病部位主要为下肢静脉(76.2%,438/575),其次为肺血管(7.1%,41/575)。(3)VTE发生的危险因素中,占比最高的危险因素是剖宫产术,为32.3%(186/575);其次是高龄,占比为27.7%(159/575);制动或孕期住院治疗占比为13.6%(78/575),其他占比在5%以上的危险因素依次为既往VTE病史、肥胖、早产、辅助生殖技术受孕等,子痫前期和多胎妊娠的占比均为4.9%(28/575)。此外,VTE孕产妇中23.1%(133/575)无上述危险因素。结论妊娠期及产褥期VTE的发生与多种危险因素有关,且可导致孕产妇死亡,非常有必要对所有孕产妇进行VTE高危因素的筛查并采取相应的防治措施。

Objective To investigate and analyze disease status and risk factors of venous thromboembolism(VTE)during pregnancy and puerperium in our country.Methods Clinical datas were collected from 575 patients diagnosed with VTE during pregnancy and puerperium and hospitalized in nine medical institutions in our country from January 1,2015 to November 30,2019,and retrospectively analyzed it′s disease status and risk factors.Results(1)The proportion of VTE in pregnancy and puerperium was 50.6%(291/575)and 49.4%(284/575),respectively.Four patients died,the mortality rate was 0.7%(4/575).The cause of death was pulmonary embolism.(2)The location of VTE during pregnancy and puerperium was mainly in the lower limb vascular(76.2%,438/575),followed by pulmonary vessels(7.1%,41/575).(3)In the risk factors of VTE,cesarean section accounted for 32.3%(186/575),maternal advance age accounted for 27.7%(159/575),braking or hospitalization during pregnancy accounted for 13.6%(78/575),other risk factors accounted for more than 5%were previous VTE,obesity,preterm birth,assistant reproductive technology conception and so on,pre-eclampsia and multiple pregnancy accounted for 4.9%(28/575)respectively.In addition,some patients with VTE did not have any of the above risk factors,and the incidence rate was as high as 23.1%(133/575).Conclusions The occurrence of VTE during pregnancy and puerperium is related to multiple risk factors,and could lead to matemal death,It is very necessary to screen VTE risk factors for all pregnant women,to make corresponding prevention and control measures.