| 引用本文： |
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车荣华,裴锦丹,万 盛,等.肺栓塞产妇临床高危因素及生物指标分析[J].同济大学学报（医学版）,2022,43(1):63-69. [点击复制]
- CHE Ronghua,PEI Jindan,WAN Sheng,et al.Clinical characteristics and risk factors of puerperal pulmonary embolism[J].同济大学学报（医学版）,2022,43(1):63-69. [点击复制]
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| 摘要: |
| 目的 探讨产妇肺栓塞(pulmonary embolism, PE)的临床特征、生物特点及危险因素。方法 收集2019年1月—2021年1月在同济大学附属第一妇婴保健院分娩的疑似诊断肺栓塞并行CT肺动脉血管造影（computer tomography pulmonary angiography, CTPA）的582例患者的临床资料进行回顾性分析，其中87例确诊为PE，495例为非PE。对发生PE的危险因素进行单因素及多因素Logistic回归分析。结果 PE中血BNP、总胆固醇、载脂蛋白B的平均水平明显高于非PE组，且差异有统计学意义（P<0.05），而孕晚期及产后第2天的平均D-二聚体水平和平均纤维蛋白原、同型半胱氨酸水平等在两组之间差异无统计学意义（P>0.05）；PE组中辅助生殖、多胎妊娠、产后出血、久卧、高D-二聚体(>3 mg/L)、下肢静脉血栓等因素发生率明显高于非PE组，两组比较差异有统计学意义（P<0.05）,但产前血栓评分及产后血栓评分两组间差异无统计学意义（P>0.05）；下肢静脉血栓、久卧、高血脑钠肽水平、高胆固醇水平、高D-二聚体水平(>3 mg/L)是发生PE的独立危险因素。结论 结合妊娠相关的血栓危险因素和生物学指标，对孕产妇加强监护，预测和减少PE的发生风险都是非常必要的。 |
| 关键词: 肺栓塞 静脉血栓栓塞症 产褥期 危险因素 CT肺动脉血管造影 |
| DOI：10.12289/j.issn.1008-0392.21152 |
| 投稿时间：2021-04-16 |
| 基金项目:上海市卫生健康委员会卫生行业临床研究专项（202040128）；上海市浦东新区卫生健康委员会联合课题（PW2019D-13) |
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| Clinical characteristics and risk factors of puerperal pulmonary embolism |
| CHE Ronghua,PEI Jindan,WAN Sheng,LI Hua,HUA Xiaolin |
| (Department of Obstetrics, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai 201204, China) |
| Abstract: |
| Objective To investigate the clinical characteristics and risk factors of pulmonary embolism(PE) in puerpera. Methods Clinical data of 582 patients with suspected puerperal pulmonary embolism admitted in Shanghai First Maternity and Infant Hospital from January 2019 to January 2021 were retrospectively analyzed. All patients underwent CT pulmonary angiography(CTPA) examination and PE was confirmed in 87 cases(PE group). The clinical characteristics were compared between PE group and non-PE group(n=495). The risk factors of PE were analyzed by univariate and multivariate logistic regression analyses. Results The blood levels of BNP, total cholesterol and lipoprotein B in PE were significantly higher than those of non-PE group(P<0.05) ; while there were no significant differences in blood levels of D-dimer, fibrinogen and homocysteinein in the third trimester and the second day after delivery between two groups(P>0.05). The proportions of patients with assisted reproduction, multiple pregnancy, postpartum haemorrhage, long brake, high D-dimer(>3 mg/L), lower limb venous thrombosis in PE were significantly higher than those of non-PE group(P<0.05). However, there were no significant differences in prepartum risk score and the postpartum risk score between two groups(P>0.05). Lower limb venous thrombosis, long brake, high blood BNP level, high blood cholesterol level, high D-dimer level were independent risk factors for PE. Conclusion Based on risk factors of pregnancy-related thrombosis it is necessary to strengthen the monitoring of pregnant and parturient women to predict and reduce the risk of PE during puerperium. |
| Key words: pulmonary embolism venous thromboembolism puerperium risk factors computer tomography pulmonary angiography |
