妊娠期及产褥期孕产妇静脉血栓形成的危险因素及临床特征分析

Risk factors and clinical characteristics of venous thrombosis in pregnant and puerperal pregnant women

目的调查分析妊娠期及产褥期孕产妇静脉血栓形成的发病现状、危险因素及临床特征。方法回顾性分析2018年1月1日至12月31日于中国9个地区11家医疗单位(10家三级甲等医院、1家二级甲等医院)客观诊断为静脉血栓形成的孕产妇139例临床资料(其中有1例患者临床资料不全,后期分析仅纳入138例患者)。根据静脉血栓形成的时间分为妊娠期、产褥期两组,分析孕产妇静脉血栓形成的发病现状、危险因素及临床特征。结果(1)妊娠期及产褥期静脉血栓形成的发生率为0.09‰~5.89‰。(2)138例静脉血栓形成患者中包括妊娠期孕妇33例(23.9%),产褥期产妇105例(76.1%);血栓形成相关的危险因素中不运动或脱水、年龄≥35岁、妊娠合并症、妊娠期或产褥期的外科手术(除外会阴缝合术)依次占比为34.1%(47/138)、32.6%(45/138)、32.6%(45/138)、22.5%(31/138)。产褥期血栓形成产妇中剖宫产占比为92.4%(97/105),所有产妇中仅有10.1%(14/138)无相关危险因素。(3)妊娠期或产褥期血栓形成以下肢深静脉血栓形成为主(73.2%,101/138),深静脉血栓好发于左下肢(73.3%,74/101);上肢浅静脉血栓孕产妇中有10.0%(2/20)合并深静脉血栓,下肢浅静脉血栓孕产妇中有57.1%(8/14)合并深静脉血栓。(4)共4例孕产妇发生肺栓塞(2.9%,4/138),中孕、晚孕各1例,产褥期2例;3例孕产妇经积极救治后存活,1例死亡。结论妊娠期及产褥期有必要对所有孕产妇进行静脉血栓形成危险因素筛查,以便早期识别出高危孕产妇进而予以必要的预防或治疗。

Objective To investigate and analyze the current status,risk factors and clinical characteristics of venous thrombosis in women during pregnancy and puerperium.Methods A retrospective analysis was made in 139 women who was objectively diagnosed with venous thrombosis in 11 medical units in 9 provinces and cities(10 third-class hospitals,1 second-class hospital)from January 1,2018 to December 31,2018.The clinical data of 139 pregnant and puerperal women was analyzed(1 of the 139 patients had incomplete clinical data,so only 138 patients were included in the later analysis).According to the time of venous thrombosis,they were divided into two groups:pregnancy and puerperium,and the current status,risk factors and clinical characteristics of venous thrombosis were analyzed retrospectively.Results(1)The incidence of venous thrombosis during pregnancy and puerperium varied from 0.09%o to 5.89%o.(2)Among the 138 cases of venous thrombosis,there were 33 pregnant women(23.9%)and 105 women(76.1%)in the puerperium.Among the risk factors related to thrombosis,inactivity or dehydration,age≥35 years,pregnancy comorbidities and surgical procedures during pregnancy or puerperium(excluding perineal sutures)accounted for 34.1%(47/138),32.6%(45/138),32.6%(45/138),and 22.5%(31/138).Caesarean section accounted for 92.4%(97/105)in patients with puerperal thrombosis,and only 10.1%(14/138)of patients had no associated risk factors.(3)Thrombosis during pregnancy or puerperium was dominated by lower extremities deep vein thrombosis(73.2%,101/138).Deep vein thrombosis is more common in the left lower extremity(73.3%,74/101),and 10.0%(2/20)of patients with superficial vein thrombosis of upper extremities had deep vein thrombosis,while 57.1%(8/14)of patients with superficial vein thrombosis of lower extremities had deep vein thrombosis.(4)Four(2.9%)patients in this study had pulmonary embolism(4/138),1 case occurred in the second trimester,1 case occurred in the third trimester,and 2 cases occurred in the puerperium;3 cases survived after positive treatment and 1 case died.Conclusion During pregnancy and puerperium,it is necessary to screen all women for risk factors of venous thrombosis in order to identify high-risk patients early and provide necessary preventive or therapeutic measures.