重视妇产科静脉血栓栓塞症的综合预防

正静脉血栓栓塞症(venous thromboembolism,VTE)包括深静脉血栓形成(deep vein thrombosis,DVT)及肺栓塞(pulmonary embolism,PE)~([1])。VTE是继急性心肌梗死、脑卒中后的第三大血管性疾病,其较高的发生率和病死率引起了世界各国的关注。1妇产科疾病与VTE密切相关研究表明,VTE在妇科、产科、计划生育、辅助     

妇科手术中静脉血栓栓塞症的围手术期评估与预防

静脉血栓栓塞症（venous thromboembolism, VTE）是妇产科围手术期严重的并发症,是导致围手术期患者死亡的重要原因之一。围手术期对患者进行VTE发生危险评估、分级,并根据科学评估后的危险分级采取正确的预防措施,包括物理治疗及药物预防,对于降低VTE的发生风险具有重要的意义。     

妇科手术后静脉血栓栓塞症临床分析

目的:探讨妇科手术后静脉血栓栓塞症(VTE)的发生情况、危险因素及改良Caprini模型的运用。方法:选择四川大学华西第二医院2017年12月至2018年12月期间收治的妇科手术后发生VTE的35例患者为血栓组,另按照1∶4比例选择同期因相同疾病手术未发生VTE的140例患者为对照组。根据改良Caprini风险评估模型(不包括实验室检查结果,如V因子、凝血酶原20110A、血清同型半胱胺酸、狼疮抗凝物等)进行评分,对术后发生VTE的相关因素进行多因素Logistic回归分析。结果:①妇科手术患者共13211例,术后VTE发生率为0.26%(35/13211)。②血栓组改良Caprini平均得分高于对照组(5.20±1.83分vs 4.27±1.82分,P=0.011),血栓组改良Caprini评分≥5分的比例高于对照组(62.86%vs 44.29%,P=0.049)。③单因素分析发现妇科手术后发生VTE与年龄、BMI、手术时间及住院天数有关;多因素Logistic回归分析提示BMI≥24 kg/m^2(OR2.862,95%CI 1.277~6.417)、手术时间(OR 1.004,95%CI 1.001~1.008)是妇科术后VTE发生的独立危险因素(P<0.05)。④采用低分子肝素皮下注射抗凝治疗,同时对血栓所在的下肢制动,35例患者在观察期间均未继发出血。结论:VTE是妇科手术后严重的并发症,术后VTE发生的危险因素包括BMI(≥24 kg/m^2)、手术时间。根据改良Caprini风险度分级采取适当的预防措施,减少临床VTE的发生。     

我国妇产科静脉血栓栓塞症发生率研究现状

我国妇科术后静脉血栓栓塞症（VTE）发生率为0.02%～2.26%,孕产妇围产期VTE发生率为0.056%～0.188%。但由于研究方法的缺陷,VTE发生率可能被低估。建议开展大规模、多中心、前瞻性流行病学调查,健全和完善各地孕产妇保健系统,以准确估计VTE发生率,为其治疗和预防提供可靠依据。     

妇科恶性肿瘤围术期静脉血栓栓塞症的高危因素研究及对策

目的 分析妇科恶性肿瘤住院手术治疗患者的围术期静脉血栓栓塞症（VTE）发生的高危因素。方法 纳入本市电子病历系统登记的初次手术治疗的妇科恶性肿瘤患者共2364例,根据围术期是否发生VTE分为[VTE（+）组,110例],其他纳入对照组[VTE（-）组,2254例]。分析发生VTE的高危因素。结果 妇科恶性肿瘤患者围术期VTE发生的高危因素包括年龄≥57.5岁、合并高血压、合并糖尿病、开腹手术、病理类型为子宫内膜癌。结论 妇科恶性肿瘤手术患者围术期VTE的发生受多种因素影响,在诊疗过程中应对患者进行评估并对具有高危因素患者采取预防措施,以减少围术期VTE发生,促进患者康复。     

妇科手术患者静脉血栓栓塞症的危险因素评估和改良评估模型建立

目的:探讨妇科手术患者静脉血栓栓塞症(VTE)的危险因素和改良VTE评估模型对妇科手术患者VTE发生风险的预测价值。方法:选择2020年1月1日至2022年12月31日妇科手术后并发VTE患者41例为血栓组，按照1∶4的比例抽取同期妇科手术患者164例作为非血栓组。运用单因素及多因素Logistic回归分析妇科手术后并发VTE的危险因素，构建改良VTE危险因素快速评估模型(简称改良VTE评估表),应用受试者工作特征(ROC)曲线分析其对妇科手术患者VTE的预测价值，并与Caprini血栓风险评估模型(简称Caprini量表)进行比较。结果:(1)多因素Logistic回归分析结果示，年龄≥60岁、体质量指数(BMI)≥28 kg/m2、恶性肿瘤、手术时间>3小时、血栓病史、手术前后D-二聚体(D-D)差值增大是影响妇科手术后并发VTE的独立危险因素(OR>1,P<0.05)。(2)改良VTE评估表的ROC曲线下面积(AUC)为0.963,约登指数81.10%、敏感度87.80%、特异度93.29%;Caprini量表的AUC为0.888,约登指数63.41%、敏感度73.17%、特异度90.24%。改良VTE评估表和Caprini量表分别可将92.68%和85.37%的VTE患者评估为高危或极高危，但差异无统计学意义(P<0.05)。结论:对于影响妇科手术患者VTE的6项独立危险因素临床上应重点关注。改良VTE评估表与Caprini量表对VTE识别水平相当，但其简单、易操作，具有更好的实用性，有一定的临床推广价值。     

妇科手术患者静脉血栓栓塞症的危险因素评估和评分简表的有效性验证

目的:探讨妇科手术患者静脉血栓栓塞症(VTE)危险因素及制定VTE危险因素评分简表,并对评分简表进行有效性验证。方法:收集2015年10月至2017年10月在西安交通大学第一附属医院妇科接诊并手术治疗后并发VTE的妇科肿瘤患者53例,对照组选择时间上相邻的2个妇科手术非VTE妇科肿瘤患者共106例。对年龄、体质量指数(BMI)、肿瘤性质、血栓相关病史、合并症、手术方式、手术时间、出血量、术后卧床时间、妊娠或产褥期、激素服用史进行单因素分析和多因素分析,并制定VTE危险因素的评分简表,应用该评分简表和Caprini评分表对所有患者进行评分比较。结果:单因素分析中,两组在BMI、肿瘤性质、手术时长、出血量、有无输血、卧床时间、血栓相关病史等方面差异有统计学意义(P0.05)。多因素Logistic回归结果,年龄60岁、BMI28 kg/m~2、恶性肿瘤、手术时长≥3小时、腹腔镜手术、血栓相关病史是影响妇科手术患者并发VTE的独立危险因素(P0.05)。评分简表与Caprini评分表评分情况比较,两者差异无统计学意义(P0.05)。结论:年龄大、BMI高、恶性肿瘤、手术时间长、腹腔镜手术及有血栓相关病史患者妇科手术后更易发生VTE。评分简表简便易操作且对于VTE识别度高,有一定临床实用价值。     

妊娠期及产褥期静脉血栓栓塞症风险评估及预防

目的:评估妊娠期及产褥期女性的静脉血栓栓塞症(VTE)发生风险,明确风险因素,并予以针对性预防,为探索妊娠相关VTE风险评估及预防策略提供依据.方法:根据2015年英国皇家妇产科医师学会(RCOG)妊娠期及产褥期静脉血栓栓塞疾病诊治指南推荐量表,对2018年11月1日至2019年12月31日在首都医科大学附属北京妇产医...     

不得不防的妊娠相关血栓栓塞性疾病的预防与处理

妊娠相关血栓栓塞性疾病主要是静脉血栓栓塞症(venous thromboembolism,VTE),包括深静脉血栓形成(deep vein thrombosis,DVT)和肺栓塞(pulmonary embolism,PE),其中DVT占75％～80％,而PE占20％～25％.妊娠是VTE的独立危险因素,妊娠期和产褥期...     

妇科围术期静脉血栓形成的危险因素评估

目的探讨妇科围术期静脉血栓形成的危险因素。方法回顾分析1 970例北京大学深圳医院妇科术后患者临床资料,采用统计学方法分析患者存在的危险因素与静脉血栓形成的关系。结果 1 970例手术患者中,发病患者13例,发病率为0.7%。其中,恶性肿瘤患者发病11例,占84.6%。单因素分析中,患者年龄、糖尿病、恶性肿瘤、肿瘤期别、深间质浸润、分化程度、肿瘤转移、手术方式、手术时间、术中出血量、输血与患者静脉血栓发生有关,差异有统计学意义(P0.05)。多因素分析中,恶性肿瘤晚期、低分化是静脉血栓形成的相关危险因素,差异有统计学意义(P0.05)。结论年龄及糖尿病史、恶性肿瘤、手术情况与围术期静脉血栓形成有密切关系,肿瘤分期及分化程度可能是静脉血栓形成的独立危险因素。     

Prevention of venous thromboembolism in gynecologic oncology surgery

Gynecologic oncology patients are at a high-risk of postoperative venous thromboembolism and these events are a source of major morbidity and mortality. Given the availability of prophylaxis regimens, a structured comprehensive plan for prophylaxis is necessary to care for this population. There are many prophylaxis strategies and pharmacologic agents available to the practicing gynecologic oncologist. Current venous thromboembolism prophylaxis strategies include mechanical prophylaxis, preoperative pharmacologic prophylaxis, postoperative pharmacologic prophylaxis and extended duration pharmacologic prophylaxis that the patient continues at home after hospital discharge. In this review, we will summarize the available pharmacologic prophylaxis agents and discuss currently used prophylaxis strategies. When available, evidence from the gynecologic oncology patient population will be highlighted.     

Venous thromboembolism in pregnancy

Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE). In pregnancy, deep vein thrombosis accounts for 75–80% of venous thromboembolism, the remainder are pulmonary embolisms. One half of these VTEs occur during pregnancy and the other half in the postpartum period. Venous thromboembolism is one of the leading causes of maternal mortality worldwide and is also the cause of significant maternal morbidity. This article discusses the risk factors for VTE in pregnancy, the management of the pregnant woman at risk both antenatally and postpartum and the acute management of VTE when it occurs during pregnancy.     

Risk of venous thrombo-embolic events in pregnant patients with cancer

Objective: Venous thromboembolism (VTE) is one of the leading causes of pregnancy-associated death in the Western world. Cancer is a known risk factor for thrombosis outside of pregnancy. The objective of this study is to evaluate the effect of cancer on the risk of VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE) in pregnancy.

Methods: We conducted a retrospective population-based cohort study using the Health Care Cost and Utilization Project database from 2003 to 2011. Risk of developing DVT, PE and VTE among pregnant patients with the 10 most prevalent malignancies was measured using unconditional logistic regression analysis.

Results: A total of 2826 women were identified with underlying malignancies, among our study cohort of 7?917?453 women. Risk of VTE was increased among pregnant patients with cervical cancer (OR 8.64, 95% CI (2.15–34.79)), ovarian cancer (OR 10.35, 95% CI (1.44–74.19)), Hodgkin’s disease (OR 7.87, 95% CI (2.94–21.05)) and myeloid leukemia (OR 20.75, 95% CI (6.61–65.12)). There was no increased risk of VTE among women with brain cancer, thyroid cancer, melanoma and lymphoid leukemia.

Conclusion: Many cancers may increase risk of VTE in pregnancy. Appropriate thromboprophylaxis should be considered in some of these women, particularly those with hematological malignancies and gynecologic cancers.     

Venous thromboembolism in pregnancy

Venous thromboembolism remains a common cause of direct maternal deaths in high-income settings such as the United Kingdom. Pregnancy alone increases the risk of deep vein thrombosis and pulmonary embolus at least five-fold, and many women develop or have additional risk factors for venous thrombosis during pregnancy and the puerperium, the latter representing the period of highest risk. Early and repeated risk stratification and adequate thromboprophylaxis, usually with low molecular weight heparin, is the key to preventing venous thromboembolism (VTE). Women with a past history of VTE, and those affected by thrombophilia, require multidisciplinary care involving an obstetric haematologist. Women suspected of having acute thromboembolism should be commenced on empirical treatment promptly prior to diagnostic confirmation. Pulmonary embolism should be considered as a differential diagnosis in maternal collapse.     

影像学检查在妊娠期静脉血栓栓塞症诊断中的应用

静脉血栓栓塞症在妊娠期发生率较正常人明显增高,是妊娠期的一种严重并发症。下肢深静脉血栓形成与肺栓塞有重要相关性,及早发现,及时治疗可改善孕产妇预后。影像学检查在静脉血栓栓塞症的诊断方面具有重要作用。     

剖宫产术后静脉血栓形成的预防

目前,围产期血栓栓塞性疾病发病率及病死率呈显著上升趋势,这多是继发于剖宫产术后形成的静脉血栓。剖宫产现已明确为静脉血栓栓塞症高危因素,这不仅与手术因素相关,也与大多数剖宫产合并病理产科因素相关。目前,普遍认为剖宫产术后抗凝治疗的出血风险大于收益,因此,术后多数并未进行预防性抗凝治疗。但随着高危产妇增多,为求最大程度降低不良结局,应权衡剖宫产术后出血及血栓风险,合理对高危产妇进行预防性抗凝治疗。文章从临床角度,总结国内外相关文献,探讨剖宫产术后如何评估血栓风险,并对血栓栓塞事件的有效预防,以确定选择抗凝预防干预的最佳时机进行探讨。