102例围生期孕产妇下肢深静脉血栓形成的临床研究及预后影响因素分析

Clinical study and prognostic influencing factors of deep venous thrombosis in 102 perinatal women

目的分析比较围生期孕产妇下肢深静脉血栓形成(DVT)的特征及疗效,观察预后不良反应发生情况并探索影响预后的危险因素。方法选取2016年3月至2019年3月四川省宜宾市第二人民医院诊治的102例围生期DVT孕产妇作为研究对象(DVT组)。选取同期四川省宜宾市第二人民医院收治的100例未发生DVT的孕产妇作为对照组。对DVT组采取一般治疗及溶栓治疗,观察疗效和预后。采用单因素及Logistic回归分析影响DVT发生的危险因素。结果 DVT多发于孕产妇产褥期(89.22%),以左下肢(85.29%)、股静脉(40.20%)和髂外静脉(22.55%)多发,初始症状多伴有疼痛(59.80%)。DVT组中,2例由于DVT并发的肺栓塞死亡,剩余100例DVT症状均得到缓解。体重指数(BMI)≥25kg/m~2、剖腹产、产褥期卧床时间≥72h、产后出血、血清D-二聚体(D-D)水平、部分凝血酶原活化时间(ATPP)、血清抗凝血酶-Ⅲ(AT-Ⅲ)水平降低及纤维蛋白原(FIB)水平升高的围生期孕产妇DVT发生率较高(P<0.05)。其中产褥期卧床时间≥72h和产后出血是围生期孕产妇DVT发生的危险因素(P<0.05)。结论 DVT多发于孕产妇产褥期,以左下肢、股静脉和髂外静脉多发,初始症状多伴有疼痛。产褥期卧床时间≥72h和产后出血是围生期孕产妇DVT发生的危险因素。充分认识DVT发生的高危因素、及时做好预防措施、对孕产妇进行针对性护理,可减少孕产妇DVT发生的风险。

Objective To analyze and compare the characteristics and treatment effect of deep venous thrombosis(DVT) of perinatal women, and observe the occurrence of adverse prognosis and explore the risk factors affecting the prognosis. Methods 102 perinatal DVT pregnant women(DVT group) and 100 perinatal pregnant women without DVT who were treated in the Second People′s Hospital of Yibin City from March 2016 to March 2019 were selected as the research subjects and the control group, respectively. The DVT group was treated with general therapy and thrombolytic therapy, and the curative effect and prognosis were observed. The risk factors of DVT were analyzed by single factor and Logistic regression. Results DVT occurred more frequently in puerperium(89.22%), with left lower extremity(85.29%), femoral vein(40.20%) and external iliac vein(22.55%) of pregnant women. The initial symptoms were often accompanied by pain(59.80%). Of the 102 DVT patients, 2 died of pulmonary embolism complicated by DVT, and the symptoms of the remaining 100 were alleviated. BMI≥25 kg/m2, caesarean section, the time of bed rest≥72 h during puerperium, postpartum hemorrhage, serum D dimer(D-D) level, partial prothrombin activation time(ATPP), serum antithrombin-Ⅲ reduced levels(AT-Ⅲ) and fibrinogen(FIB) levels of maternal had a high incidence of DVT in the perinatal period(P<0.05). Among them, the time of bed rest≥72 h during puerperium and postpartum hemorrhage are the risk factors for perinatal maternal DVT(P<0.05). Conclusions DVT is more common in the puerperium of pregnant women, mainly in the left lower limb, femoral vein and external iliac vein, and the initial symptoms are usually accompanied by pain. Puerperium bed time ≥72 h and postpartum hemorrhage are the risk factors for DVT in perinatal pregnant women. Fully aware of the high-risk factors of DVT, timely preventive measures, and targeted care for patients can reduce the risk of DVT in pregnant women.