不同分娩方式对产后深静脉血栓形成的影响

Effect of different delivery methods on postpartum deep vein thrombosis

目的探讨不同分娩方式对产后深静脉血栓(DVT)形成的影响。方法收集2021年1月至2022年12月于首都医科大学附属北京朝阳医院住院分娩的1002例产妇的临床资料。将采用剖宫产分娩的501例产妇作为剖宫产组,采用倾向匹配法根据产妇的年龄、产次按1:1的比例选取501例同期顺产的产妇作为顺产组。比较两组产妇产后14 d内DVT的发生情况、临床指标。根据是否发生DVT将剖宫产组产妇划分为NDVT组与DVT两个亚组,比较剖宫产组不同DVT发生情况产妇的临床指标,分析剖宫产后DVT发生的危险因素。结果剖宫产组产妇产后DVT的发生率明显高于顺产组产妇,产后DVT的发生时间明显早于顺产组产妇,差异均有统计学意义(P﹤0.01)。剖宫产组产妇产后血小板计数(PLT)、白细胞计数(WBC)均明显高于顺产组产妇,血红蛋白(Hb)水平明显低于顺产组产妇,卧床时间明显长于顺产组产妇,差异均有统计学意义(P﹤0.01)。DVT组产妇产后PLT、WBC均高于NDVT组产妇,卧床时间长于NDVT组产妇,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,PLT、WBC、卧床时间均为产妇剖宫产后发生DVT的危险因素(P﹤0.05)。结论剖宫产后DVT形成的风险更高,在综合条件允许的前提下选择顺产可降低产后DVT形成的风险。对于剖宫产分娩的产妇,应根据其产后具备的危险因素给予针对性预防、治疗和护理,以降低剖宫产后DVT的发生率,提高剖宫产术后的安全性。

Objective To investigate the effect of different delivery methods on postpartum deep vein thrombosis(DVT).Method The clinical data of 1002 postpartum women who were hospitalized and delivered at Beijing Chao-Yang Hospital,Capital Medical University from January 2021 to December 2022.A total of 501 pregnant women who delivered by cesarean section were selected as the cesarean section group,and 501 postpartum women who delivered naturally during the same period were selected as the natural delivery group according to the 1:1 ratio based on their age and parity and tendency matching method.The incidence of DVT within 14 days after delivery and clinical indicators between the two groups of postpartum women were compared.According to whether DVT occured,the cesarean section group was divided into NDVT subgroup and DVT subgroup.The clinical indicators of postpartum women with different DVT incidence in the cesarean section group were compared,and the risk factors for DVT occurrence after cesarean section were analyzed.Result The incidence of postpartum DVT in the cesarean section group was significantly higher than that in the natural delivery group,and the occurrence time of postpartum DVT was significantly earlier than that in the natural delivery group,the differences were statistically significant(P<0.01).The postpartum platelet count(PLT)and white blood cell count(WBC)of the cesarean section group were significantly higher than those of the natural delivery group,and the hemoglobin(Hb)level was significantly lower than that of the natural delivery group,the bed rest time was significantly longer than that of the natural delivery group,and the differences were statistically significant(P<0.01).The postpartum PLT and WBC of the DVT group were higher than those of the NDVT group,and the bed rest time was longer than that of the NDVT group,and the differences were statistically significant(P<0.05).The results of multivariate analysis showed that PLT,WBC,and bed rest time were all risk factors for DVT in postpartum women after cesarean section(P<0.05).Conclusion The risk of DVT after cesarean section is higher.If the comprehensive conditions allow,the selection of natural delivery can reduce the risk of postpartum DVT.For women who have cesarean section,targeted prevention,treatment and care should be given according to their postpartum risk factors,so as to reduce the probability of DVT after cesarean section and improve the safety after cesarean section.