妊娠相关静脉血栓栓塞的危险因素及其预防决策

静脉血栓栓塞(VTE)是指静脉血管管腔内血液异常凝结，形成血栓而使血管完全或部分阻塞，引起血液循环障碍。VTE主要包括深静脉血栓形成(DVT)和肺栓塞，而颅内静脉窦血栓形成及卵巢静脉血栓形成等临床少见。VTE是一种非常严重，而且具有潜在致死性的妊娠并发症。孕产妇作为特殊人群，妊娠本身即为其发生VTE的危险因素，若同时合并其他可能导致VTE发生的危险因素，如孕前危险因素、产科危险因素及孕期新发或一过性危险因素等，均可导致妊娠期及产褥期妇女发生VTE的风险增高。临床如何识别VTE危险因素，并对这些高危因素进行相应管理，是产科临床亟待解决的难题。目前，我国孕产妇VTE死因构成比呈逐年上升趋势，但是迄今尚无孕产妇VTE管理的指南或专家共识。笔者拟主要参考现有的妊娠相关VTE的危险因素及其预防、诊治指南的研究证据，从妊娠期女性发生VTE的病因，妊娠期及产褥期孕产妇发生VTE的危险因素，妊娠相关VTE危险因素评估及妊娠相关VTE预防4个方面，阐述妊娠相关VTE危险因素、危险分级及其管理策略，旨在为我国妊娠相关VTE危险因素识别及规范管理，提供实用性临床指导。

Risk factors and prevention strategies of pregnancy-related venous thromboembolism

Venous thromboembolism (VTE) refers to abnormal coagulation of blood in the lumen of vein vessel, which formes a thrombus and causes blood vessel to be completely or partially blocked, then leads to blood circulation disorder. Among them, deep vein thrombosis (DVT) and pulmonary embolism are common, but cerebral venous sinus thrombosis and ovarian venous thrombosis are rare in clinical practice. VTE is a kind of very serious and potentially fatal complication of pregnancy. As a special population, pregnant women themselves are risk population of VTE. If other risk factors of VTE are combined at the same time, including pre-pregnancy risk factors, obstetric risk factors and new or transient risk factors during pregnancy, the risk of VTE in pregnancy and puerperium can be increased. How to identify the risk factors of VTE and manage these risk factors are the urgent problems in obstetrics. The proportion of causes of death of VTE in pregnant women is increasing gradually in China, but there is still no guideline or expert consensus on maternal VTE management. Based on the existing research evidences of the risk factors of pregnancy-related VTE and their prevention, diagnosis and treatment guidelines and consensus expert opinion, this paper expounds the risk factors, risk classification and management strategies of pregnancy-related VTE from four aspects: the causes of VTE in pregnancy, the risk factors of pregnancy and puerperal VTE, the risk factors assessment and prevention of pregnancy-related VTE, aiming at providing practical clinical guidance on the identification of VTE risk factors and management of pregnancy-related VTE.