妊娠和产褥期发生静脉血栓栓塞的临床特征及其影响因素分析

Clinical characteristics and influencing factors of venous thromboembolism in pregnancy and puerperium

目的观察妊娠和产褥期发生静脉血栓栓塞(VTE)患者的临床特征,并分析其发生的危险因素。方法回顾性分析2021年1月至12月东莞康华医院接收的50例妊娠和产褥期发生VTE的孕产妇资料,纳入发生VET组;另收集同期接收的50名妊娠和产褥期未发生VTE的孕产妇资料,纳入未发生VET组。查阅并记录两组产妇相关资料,分析妊娠和产褥期发生VTE的危险因素。结果发生VET组的患者症状体征主要表现为肿胀、疼痛;血栓范围主要为周围型,其中妊娠期以周围型为主,产褥期以混合型为主;血栓部位主要是下肢深静脉血栓,产褥期合并肺栓塞较多;累及静脉以肌间最多,其中妊娠期主要累及肌间,而产褥期多累及多条静脉。发生VET组的年龄、孕前体重指数高于未发生VET组,剖宫产、产后出血、合并感染性疾病发生率高于未发生VET组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,年龄大、孕前体重指数高、剖宫产、产后出血、合并感染性疾病是妊娠和产褥期发生VTE的危险因素(P<0.05)。结论发生VTE的患者主要表现为肿胀、疼痛,血栓范围主要为周围型,部位主要是下肢DVT,累及静脉以肌间最多。应重点关注年龄大、孕前体重指数高、剖宫产、产后出血及合并感染性疾病的产妇情况,积极预防VTE的发生。

Objective To observe the clinical characteristics of venous thromboembolism(VTE)in pregnancy and puerperium and analyze the related risk factors.Methods The data of 50 pregnant women with VTE during pregnancy and puerperium admitted to Dongguan Kanghua Hospital from January to December 2021 were retrospectively analyzed and included in the VET group.In addition,the data of 50 pregnant women who did not develop VTE during pregnancy and puerperium were collected and included in the non-VET group.The related data of the two groups were reviewed and recorded,and the risk factors of VTE during pregnancy and puerperium were analyzed.Results The symptoms and signs of patients with VET were mainly swelling and pain.The scope of thrombus was mainly peripheral type,which was mainly peripheral type during pregnancy and mixed type during puerperium.The main site of thrombosis was deep vein thrombosis of lower limbs,and the puerperium was more complicated with pulmonary embolism.The most involved veins were the intermuscular ones,which mainly involved the intermuscular ones during pregnancy,and more than one vein was involved during puerperium.The age and pre-pregnancy body mass index of the VET group were higher than those of the non-VET group,and the incidence of cesarean section,postpartum hemorrhage and infectious diseases were higher than those of the non-VET group,and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that older age,higher body mass index before pregnancy,cesarean section,postpartum hemorrhage and complicated infectious diseases were risk factors for VTE during pregnancy and puerperium(P<0.05).Conclusion The main manifestations of VTE patients are swelling and pain.The scope of thrombosis is mainly peripheral type,the main site is lower limb DVT,and the veins involved are most intermuscular;Older age,higher body mass index before pregnancy,cesarean section,postpartum hemorrhage and infectious diseases are the risk factors of VTE in pregnancy and puerperium.