不同分娩方式围产期血液及下肢深静脉超声指标的特征分析

Analysis of the characteristics of perinatal blood indexes and lower extremity deep vein ultrasound indexes in different delivery modes

目的研究不同分娩方式围产期血液指标、双下肢深静脉血管及血流频谱特征,拟为不同围生期孕妇血栓前状态早期诊断、治疗提供辅助依据。方法回顾2012年5月至2019年12月于妇产科住院的孕产妇2055例临床病例资料,依据分娩方式分为阴道分娩组(n=910)、择期剖宫产组(n=790)、急诊剖宫产组(n=355)。比较3组别下肢静脉内径[双侧股静脉(CFV)、腘静脉(POPV)]、血流频谱峰值、同期血液学指标,整理、分析产后并发症发生情况。结果3组产后VTE发生率比较差异有统计学意义(P<0.05)。与阴道分娩组比较,择期剖宫产及急诊剖宫产APTT、PT和TT均显著缩短,FBG和DD水平显著增加,CFV、POPV内径均显著增加,左/右侧POPV血流频谱峰值显著降低,差异均有统计学意义(P<0.05)。急诊剖宫产APTT、PT、TT与择期剖宫产相比较显著缩短,FBG和DD水平显著增加,双侧CFV内径及左侧POPV内径均显著增宽,双侧POPV血流频谱峰值显著降低,差异有统计学意义(P<0.05);右侧POPV内径及双侧CFV血流频谱峰值未见明显改变(P>0.05)。结论选择剖宫产产术孕产妇处于明显血栓前状态,急诊剖宫产孕产妇体内高凝状态较最为严重。双下肢深静脉彩色多普勒超声检查对血栓前状态具有一定的预测价值。

Objective To investigate the perinatal blood indexes,deep venous blood vessels and blood flow spectrum characteristics of lower limbs in different delivery modes,so as to provide basis for early diagnosis and treatment of pre-thrombotic state in different perinatal pregnant women.Methods The clinical data about 2055 pregnant women who were hospitalized in our hospital from May 2012 to December 2019 were retrospectively analyzed.According to the mode of delivery,who were divided into vaginal delivery group(n=910),elective cesarean section group(n=790)and emergency cesarean section group(n=335).The diameter of lower extremity vein,peak value of blood flow spectrum and hematological indexes as well as the incidence of postpartum complications were observed and compared between the three groups.Results There was a significant difference in the incidence rate of VTE after childbirth among the three groups(P<0.05).As compared with those in vaginal delivery group,the activated partial thromboplastin time(APTT),prothrombin time(PT)and thrombin time(TT)as well as POPV blood flow spectrum peak in both sides in elective cesarean section group and emergency cesarean section group were significantly decreased,however,the levels of FBG and DD as well as the CFV,POPV internal diameter were significantly increased(P<0.05).Moreover the APTT,PT,TT as well as POPV blood flow spectrum peak in both sides in emergency cesarean section group were significantly shorter than those in elective cesarean section group,but the levels of FBG and DD as well as CFV internal diameter in both sides and POPV internal diameterin left side were significantly more than those in elective cesarean section group(P<0.05).However there were no significant changes in POPV internal diameter in right side and CFV peak in both sides(P>0.05).Conclusion There exists obvious prethrombotic state in the pregnant women with selective cesarean section,which in the pregnant women with emergency cesarean section is the most serious.And color Doppler ultrasonography of deep veins of both lower limbs has a certain predictive value for the condition.