产科VTE危险因素联合D-二聚体对剖宫产术后低氧患者发生肺栓塞的预测价值分析

Analysis of the predictive value of obstetric risk factors of VTE combined with D-Dimer for pulmonary embolism in hypoxic patients after cesarean section.

目的:探讨VTE危险因素评估联合D-二聚体水平对预测剖宫产术后低氧患者发生肺栓塞的价值。方法:选取2021年5月至2023年5月于四川大学华西第二医院剖宫产术后因低氧血症行胸部大血管CT诊断为肺栓塞的产妇45例为研究组,选取同期因低氧血症行CTPA未发现肺栓塞的产妇59例为对照组。分析两组患者的年龄、终止妊娠天数、术后筛查CTPA及D-二聚体时间、术前术后是否使用低分子肝素(LMWH)、间断气压疗法(IPC)时间、术后VTE危险因素数及D-二聚体水平。绘制D-二聚体的受试者工作特征曲线(ROC)并计算ROC曲线下面积(AUC)以评估其对诊断肺栓塞的价值。对比分析不同VTE危险因素分层下两组患者的D-二聚体水平。结果:两组患者的年龄、终止妊娠天数、术后筛查CTPA及D-二聚体时间、术前术后使用LMWH、IPC率及使用时间比较,差异无统计学意义(P>0.05)。剖宫产术后因低氧血症而行CTPA并确诊为PE时间平均为(1.572±0.776)d,两组资料的VTE危险因素均>2个。研究组D-二聚体为(6.454±5.709)mg/L,高于对照组[(4.716±6.545)mg/L],差异有统计学意义(P<0.05)。ROC曲线分析显示,D-二聚体AUC 0.664,差异有统计学意义(95%CI为0.558~0.770,P<0.05);按VTE危险因素分层比较两组D-二聚体发现,VTE评估1个或≥4个危险因素者,两组D-二聚体比较差异无统计学意义;VTE评估2个或3个危险因素者,确诊组D-二聚体高于对照组,差异有统计学意义(P<0.05)。结论:剖宫产术后出现低氧血症、VTE评估超过2个危险因素或D-二聚体>(6.454±5.709)mg/L,需警惕肺栓塞可能。

Objective:To explore the value of obstetric risk factors of VTE(venous thromboembolism)combined with the level of D-Dimer in predicting Pulmonary embolism(PE)in patients with hypoxia after cesarean section.Methods:45 patients who were diagnosed as PE by CTPA due to hypoxemia after cesarean section in West China Second Hospital of Sichuan University from May 2021 to May 2023 were divided into the study group,and the 59 patients who were not diagnosed as PE by CTPA due to hypoxemia after cesarean section during the same period were divided into the control group.Analyze the age,the termination of gestational day,the time after cesarean section of screening CTPA and D-Dimer,whether using LMWH or intermittent pneumatic compression(IPC)before and after cesarean section,the time of using LMWH or IPC after cesarean section,the risk factors of VTE and the level of D-Dimer.Drawing the receiver operator characteristic curve(ROC curve)and calculating the area under ROC cure(AUC)to evaluate the values of D-Dimer for the diagnosis of PE.Comparing the D-Dimer between the two groups under different risk factors of VTE.Result:There was no statistically significant difference in the age,the time after cesarean section of screening CTPA and D-Dimer,whether using LMWH or IPC before and after cesarean section.The average time of diagnosing PE due to hypoxemia by CTPA was(1.572±0.776)days,the risk factors of VTE of the both tow groups were greater than 2,the D-Dimer in the diagnosed group was(6.454±5.709)mg/L,which was higher than the control group(P<0.05).The AUC of D-Dimer of the two groups was 0.664(95%CI 0.558~0.770,P<0.05).In the one and more than four risk factors of VTE,there was no statistically significant difference between the two groups.In the two and three risk factors of VTE,the D-Dimer in the diagnosed group was higher than the control group(P<0.05).Conclusion:It is necessary to be alert to the possibility of PE in the case of patient who with hypoxemia after cesarean section,more than two risk factors of VTE was assessed and D-Dimer>(6.454±5.709)mg/L.