产后血栓性疾病的危险因素分析

Analysis of risk factors for postpartum thrombotic disease

目的·探讨产后血栓形成的高危因素,为产后血栓的预防提供指导。方法·回顾性分析2018—2020年间于上海交通大学医学院附属国际和平妇幼保健院分娩的孕产妇电子病例45262例,其中病例组60例,为诊断为产后静脉血栓或者肺栓塞的产妇;对照组45202例,为未发生产后血栓的产妇。通过多因素Logistic回归分析寻找产后血栓发生的危险因素。结果·产后静脉血栓的发病率为130/10万,肺栓塞46/10万,产后血栓性疾病的发病率呈现逐年增高的趋势(P<0.05),产后血栓的发生部位以左下肢为主。病例组产妇分娩时的平均年龄为(33.52±4.79)岁,对照组的平均年龄为(31.35±4.01)岁。病例组中发生早产的产妇占比是对照组的2.05倍,孕前超重及肥胖的产妇占比是对照组的1.94倍。多因素Logistic回归分析显示产妇年龄大(aOR=1.10,95%CI 1.04~1.17)、分娩孕周小(aOR=0.88,95%CI 0.78~0.99)、本科学历以下(aOR=2.24,95%CI 1.20~4.18)、择期剖宫产(aOR=6.68,95%CI 2.56~17.41)、急诊剖宫产(aOR=14.40,95%CI 5.37~38.63)及孕前超重和肥胖(aOR=1.91,95%CI 1.04~3.49)的产妇发生产后血栓的风险增加。结论·产妇年龄大、受教育程度低、分娩孕周小、超重以及剖宫产的分娩方式是产后血栓的独立危险因素,其中最突出的危险因素是急诊剖宫产。产后静脉血栓的发生和多种危险因素相关,且可导致孕产妇死亡,临床上需要及时做好血栓风险的评估工作,对于有高危因素的产妇尽早进行预防措施,以降低产后血栓的发生。

Objective·To explore the high-risk factors and provide guidance for the prevention of postnatal thromboembolism.Methods·Based on a retrospective case-control design,a total of 45262 electronic cases of women giving birth in the International Peace Maternal&Child Health Hospital,Shanghai Jiao Tong University School of Medicine from 2018 to 2020 were excavated.The case group was 60 parturients diagnosed with postpartum venous thrombosis or pulmonary embolism,while the control group was 45202 parturients who were normal.Multivariate logistic regression analysis was used to find the risk factors of postpartum thrombosis.Results·The incidence of postpartum venous thrombosis was 130/100000 and pulmonary embolism was 46/100000.The incidence of postpartum thrombotic disease showed a trend of increasing year by year(P<0.05).The left lower extremity was the main site of postpartum thrombosis.In this study,the average age of the mothers at delivery was 33.52±4.79 years old in the case group and 31.35±4.01 years old in the control group.The proportion of preterm birth in the case group was 2.05 times that of the control group,and the proportion of pre-pregnancy overweight and obese was 1.94 times that of the control group.Multivariate Logistic regression analysis showed that the elder age(aOR=1.10,95%CI 1.04-1.17),the smaller the gestational age(aOR=0.88,95%CI 0.78-0.99),less than a bachelor’s degree(aOR=2.24,95%CI 1.20-4.18),elective caesarean(aOR=6.68,95%CI 2.56-17.41),emergency caesarean(aOR=14.40,95%CI 5.37-38.63)and pre-pregnancy overweight and obesity(aOR=1.91,95%CI 1.04-3.49)all increased the risk of postpartum thrombosis.Conclusion·Maternal age,education level,gestational age,overweight and cesarean section were independent risk factors for postpartum thrombosis.The most prominent risk factor was emergency cesarean section.The occurrence of postpartum venous thrombosis was associated with a variety of risk factors and can lead to maternal death.Clinicians need to assess the risk of thrombosis in time,and take preventive measures as soon as possible for women with high risk factors to reduce the risk of postpartum thrombosis.