剖宫产术后下肢深静脉血栓形成的危险因素分析

目的:探讨剖宫产手术后下肢深静脉血栓(LEDVT)发生的危险因素。方法:选取2008年1月～2012年1月在唐山市妇幼保健院、工人医院及协和医院行剖宫产术共20 998例患者,术前完善相关化验,术后2～7天行双下肢静脉彩超检查,除LEDVT患者外,在整个人群中随机选取LEDVT 2倍人群作为对照组,对影响LEDVT的因素进行单因素和多因素Logistic回归分析。结果 :①符合术后LEDVT诊断标准者共716例,发生率为3.41%。②计量资料中,病例组的体重指数、部分凝血酶原活化时间、纤维蛋白原、D二聚体、抗凝血酶-Ⅲ、C反应蛋白均高于对照组;计数资料中,病例组的高血压病史、糖尿病病史、吸烟史、血栓史、口服避孕药史的LEDVT患病率均高于对照组。③单因素Logistic回归分析显示,年龄、体重指数、部分凝血酶原活化时间、D二聚体、抗凝血酶-Ⅲ、C反应蛋白、高血压病史、糖尿病病史、吸烟史、血栓史、口服避孕药史、缺乏体育锻炼等均为深静脉血栓形成的独立危险因素;多因素Logistic回归分析显示,年龄、体重指数、D二聚体、抗凝血酶-Ⅲ、C反应蛋白是深静脉血栓形成的独立危险因素。结论 :剖宫产术后LEDVT的发生率较高;LEDVT的发生与年龄、体重指数、D二聚体、抗凝血酶-Ⅲ、C反应蛋白有关。建议对有LEDVT高危因素的患者术后2～7天常规筛查下肢深静脉血栓,加强术后护理及治疗,以减少LEDVT并发症发生。

Analysis on the risk factors of lower extremity deep venous thrombosis after cesarean section

Objective:To explore the risk factors of lower extremity deep venous thrombosis(LEDVT) after cesarean section.Methods:A total of 20 998 patients who underwent cesarean section in Tangshan maternal and child health hospital,Tangshan worker’s hospital,and Xiehe hospital from January 2008 to January 2012 were selected,related tests were carried out before cesarean section,then color ultrasonography of bilateral lower extremities was performed at 2-7 days after cesarean section;except the patients with LEDVT,two times of peoples were selected from the whole population as control group;the influencing factors of LEDVT were analyzed by univariate and multivariate logistic regression analysis.Results:A total of 716 postoperative patients met the diagnostic criteria of LEDVT,the incidence of LEDVT was 3.41%.Among the measurement data,the body mass index(BMI),activated partial thromboplastin time(APTT),fibrinogen,D-dimer,antithrombin Ⅲ,and C-reactive protein(CRP) in case group were statistically significantly higher than those in control group.Among the enumeration data,the incidences of LEDVT in the patients with the histories of hypertension,diabetic mellitus,smoking,thrombus,and oral administration of contraceptive were significantly higher than those in control group.Univariate logistic regression analysis showed that age,BMI,APTT,D-dimer,antithrombin Ⅲ,CRP,the medical histories of hypertension,diabetic mellitus,smoking,thrombus,and oral administration of contraceptive,and lacking sports were the independent risk factors of LEDVT;multivariate logistic regression analysis showed that age,BMI,D-dimer,antithrombin Ⅲ,and CRP were the independent risk factors of LEDVT.Conclusion:The incidence of LEDVT after cesarean section was high;the occurrence of LEDVT was correlated with age,BMI,D-dimer,antithrombin Ⅲ,and CRP.It is suggested to screen LEDVT routinely at 2-7 days after cesarean section for the patients with high risk factors of LEDVT and enhance postoperative nursing and treatment to reduce the occurrence of LEDVT complications.