围生期孕产妇下肢深静脉血栓形成临床分析

目的 分析孕产妇并发下肢深静脉血栓(DVT)的高危因素、早期诊治及结局.方法 对2009年至2016年首都医科大学附属北京妇产医院收治的28例孕产期下肢深静脉血栓形成患者的临床资料进行回顾性研究,并与同期分娩的280例未发生DVT孕妇进行对比,分析其高危因素、早期诊治及母儿结局.结果 研究组28例患者中DVT发生在妊娠期5例,发生在产褥期23例.单因素分析显示与对照组相比,高龄及剖宫产分娩是发生DVT的危险因素(χ2值分别为4.031、18.070,均P<0.05).而其他危险因素如孕前体质指数(BMI)≥24kg/m2、体外授精-胚胎移植(IVF-ET)术后、双胎妊娠、产后出血≥1 000mL等与DVT的发生无明显相关性(均P>0.05),但93%患者都有1~4项高危因素.研究组所有患者均进行了抗凝治疗,所有患者正常生存,无不良预后.结论 孕产妇在妊娠期及产褥期血液处于高凝状态,存在高危因素时深静脉血栓形成的风险明显增加,D-二聚体值升高对诊断深静脉血栓无特异性,对于确诊深静脉血栓形成的孕产妇,抗凝治疗是有效的措施.

Clinical analysis of deep vein thrombosis in perinatal women

Objective To analyze the high risk factors, early diagnosis and treatment and outcomes of pregnant women with deep vein thrombosis (DVT).Methods A retrospective study was conducted on data of 28 pregnant women with DVT admitted in Beijing Obstetrics and Gynecology Hospital of Capital Medical University from 2009 to 2016, and the data was compared with that of 280 cases without DVT who delivered at the same period to analyze the high risk factors, early diagnosis and treatment and outcomes.Results In 28 cases in study group, DVT was found in gestation period in 5 cases and in puerperium in 23 cases.Univariate analysis showed that advanced age and cesarean delivery were risk factors of DVT (χ2 value was 4.031 and 18.07, respectively, both P<0.05), while other risk factors such as BMI≥24kg/m2, IVF-ET, twin pregnancy, postpartum hemorrhage≥ 1000mL were not significantly correlated with DVT(all P>0.05).There were 1-4 risk factors in 93% patients in DVT group.All of 28 patients received anticoagulant therapy and no adverse outcomes were found.Conclusion Women in gestation and early puerperium are in hypercoagulable state.The risk of DVT increases remarkably when high risk factors accompany.The rising of D-Dimer is non-specific in diagnosis of DVT.Anticoagulant therapy is effective in treatment of DVT.