分娩方式对高龄、适龄产妇D-二聚体水平的影响及临床意义分析

Effect of delivery mode on D-dimer level of elderly and school-age parturients and its clinical significance

目的分析分娩方式对高龄、适龄产妇D-二聚体水平的影响,并探讨其临床意义。方法回顾性选取2016年11月至2019年11月于西安市第四医院产科分娩的522例产妇,其中经阴道分娩的产妇263例(阴道分娩组),经剖宫产分娩的产妇259例(剖宫产组)。比较两组产妇产前1周内及产后1、3、5 d的血浆D-二聚体水平;比较两组<35岁及≥35岁产妇产前1周内及产后1、3、5 d的D-二聚体水平;统计产后并发静脉血栓栓塞性疾病的产妇人数,分析其临床特点及血浆D-二聚体水平变化趋势。结果产后1、3 d,两组的D-二聚体水平均升高,产后5 d有所下降(P<0.05);产后1、3 d,剖宫产组的D-二聚体水平明显高于阴道分娩组(P<0.05)。产后1、3 d,剖宫产组≥35岁产妇D-二聚体水平高于<35岁产妇(P<0.05);产后1、3 d,剖宫产组<35岁及≥35岁产妇的D-二聚体水平高于阴道分娩组(P<0.05)。8例发生静脉血栓栓塞性疾病的剖宫产产妇中,1例年龄<35岁,其余均≥35岁。结论剖宫产分娩方式对高龄产妇D-二聚体水平的影响更显著,且剖宫产高龄产妇产后机体可能呈现出明显高凝状态,临床应密切关注其产后5 d内的D-二聚体水平及其变化趋势,以防出现血栓栓塞性疾病。

Objective To analyze the effect of delivery mode on the level of D-dimer of elderly and school-age parturients,and to explore its clinical significance.Methods A total of 522 parturients who gave birth in the obstetrics department of Xi'an fourth hospital from November 2016 to November 2019 were selected retrospectively,including 263 cases of vaginal delivery(vaginal delivery group)and 259 cases of cesarean section delivery(cesarean section group).The plasma D-dimer level were compared between the two groups within 1 week before and 1,3 and 5 d after delivery;the plasma D-dimer level of parturients with<35 years old and≥35 years old within 1 week before and 1,3 and 5 d after delivery were compared between the two groups;the number of postpartum parturients complicated with venous thromboembolic diseases was counted,and their clinical characteristics and the change trend of plasma D-dimer level were analyzed.Results The level of D-dimer increased at 1 and 3 d after delivery and decreased at 5 d after delivery in the two groups(P<0.05);at 1 and 3 d after delivery,the level of D-dimer in the cesarean section group was significantly higher than that in the vaginal delivery group(P<0.05).At 1 and 3 d after delivery,the level of D-dimer of parturients aged≥35 years old was higher than that of parturients aged<35 years old in the cesarean section group(P<0.05);at 1 and 3 d after delivery,the level of D-dimer in parturients aged<35 years old and≥35 years old in the cesarean section group were higher than those in the vaginal delivery group(P<0.05).Among the 8 cases of cesarean section with venous thromboembolic diseases,1 case was<35 years old,and the rest were≥35 years old.Conclusion The delivery mode of cesarean section has a more significant impact on the level of D-dimer in elderly parturients,and the body of elderly parturients after cesarean section may show an obvious hypercoagulable state.Clinically,we should pay close attention to the level of D-dimer and its change trend within 5 d after delivery to prevent venous thromboembolic diseases.