剖宫产患者术后下肢静脉栓塞发生状况及影响因素

Occurrence and Influencing Factors of Lower Extremity Venous Embolism in Patients After Cesarean Section

目的探讨剖宫产患者术后下肢静脉栓塞发生情况及相关影响因素,为临床制定针对性防治方案提供参考。方法回顾性分析,收集2018年3月至2020年8月于中牟县妇幼保健院进行剖宫产的385例患者临床资料,了解患者术后2~7 d下肢静脉栓塞发生情况。根据患者术后下肢静脉栓塞发生情况将其分为发生下肢静脉栓塞组及未发生下肢静脉栓塞组,查阅并比较两组患者一般资料,采用Logistic回归分析探索剖宫产患者术后发生下肢静脉栓塞的影响因素。结果385例剖宫产患者术后有21例发生下肢静脉栓塞,下肢静脉栓塞发生率为5.45%;术后发生下肢静脉栓塞组与未发生下肢静脉栓塞组的年龄、分娩时孕周、孕次、产次、巨大儿、口服避孕药史、多胎妊娠、血栓史、血清甘油三酯(TG)、总胆固醇(TC)水平相比对比,差异无统计学意义(P>0.05);发生下肢静脉栓塞组患者血浆D-二聚体(D-D)水平≥2.6 mg/mL、血清C-反应蛋白(CRP)水平>10.0 mg/L、妊娠前身体质量指数(BMI)>24 kg/m^(2)、术后活动时间≤3h/d、合并糖尿病占比大于未发生下肢静脉栓塞组患者,差异有统计学意义(P<0.05);Logistic回归分析发现,血浆D-D水平≥2.6 mg/mL、血清CRP水平>10.0 mg/L、妊娠前BMI>24 kg/m^(2)、术后活动时间≤3 h/d、合并糖尿病均是剖宫产患者术后发生下肢静脉栓塞的危险因素(OR>1,P<0.05)。结论剖宫产患者术后下肢静脉栓塞具有一定发生风险,血浆D-D水平≥2.6 mg/L、血清CRP水平>10.0 mg/L、妊娠前BMI>24 kg/m^(2)、术后活动时间≤3 h/d、合并糖尿病均是剖宫产患者术后发生下肢静脉栓塞的危险因素。

Objective To investigate the occurrence and related influencing factors of venous embolism in the lower extremity after cesarean section,and to provide a reference for the clinical development of targeted prevention and treatment programs.Methods Clinical data of 385 patients who underwent cesarean section in Zhongmou County Maternal and Child Health Hospital from March 2018 to August 2020 were retrospectively analyzed to understand the occurrence of venous embolism in the lower extremity 2 to 7 days after surgery.According to the occurrence of postoperative lower extremity venous embolism,patients were divided into groups with and without lower extremity venous embolism.General data of the two groups were consulted and compared,and the influencing factors of postoperative lower extremity venous embolism in patients with cesarean section were explored by Logistic regression analysis.Results Among 385 cases of cesarean section,21 cases had lower extremity venous embolism,and the incidence of lower extremity venous embolism was 5.45%.There was no significant difference in age,gestational week at delivery,gestational time,delivery time,macrocephaly,oral contraceptive history,multiple pregnancies,history of thrombosis,serum triglyceride(TG),and total cholesterol(TC)levels between the group with and without venous embolization(P>0.05).In the lower extremity venous embolization group,plasma D-dimer(D-D)level≥2.6 mg/mL,serum C-reactive protein(CRP)level>10.0 mg/L,pre-pregnancy body mass index(BMI)>24 kg/m^(2),postoperative activity time≤3 h/d,the proportion of patients with diabetes mellitus was higher than that without lower extremity venous embolization,and the difference was statistically significant(P<0.05).Conclusion There is a certain risk of lower extremity venous embolism in patients with cesarean section.Plasma D-D level≥2.6 mg/L,serum CRP level>10.0 mg/L,pre-pregnancy BMI>24 kg/m^(2),postoperative activity time≤3 h/d,and diabetes mellitus are all risk factors for lower extremity venous embolism in patients with cesarean section.