孕产妇静脉血栓栓塞发病率的研究

发布时间：2019-01-30 10:43

【摘要】：背景：静脉血栓栓塞（venous thromboembolism，VTE）的发生率在孕期和产后有所增加。已有很多文献对静脉血栓栓塞在孕期和产后的发生率进行了统计，然而所报道的发生率有很大差异。 目的：本研究旨在通过Meta分析的方法对既有的相关研究进行数据合并与综合，进而得到一个相对客观和稳定的结果。 方法：检索PubMed, EMBase, CNKI和万方数据库中关于孕期和产后静脉血栓栓塞流行病学的研究。根据己拟定的纳入/排除标准对检索到的文献进行筛选。使用统计软件计算合并效应值及其95%可信区间（confidence interval，CI）。静脉血栓栓塞、深静脉血栓（deep vein thrombosis，DVT)、肺栓塞（pulmonary embolism，PE)的发生率和肺栓塞的死亡率的合并使用R软件。VTE在产前产后的分布以及DVT在左右腿的分布情况在Beta3.13中进行合并。通过亚组分析观察VTE、DVT和PE在产后发生率的差异，进行敏感性分析对结果的稳定性进行评价，使用Egger's检验评估发表偏倚。 结果：我们共纳入27篇研究，VTE发生率为1.4‰(1.0-1.8‰)，DVT发生率为1.1‰(1.0-1.3‰), PE发生率为0.3‰(0.2-0.4‰), PE死亡率为6.58%(3.30-13.09%)。VTE在产后的发生比例为57.5%(50.9-63.9%)，VTE在早、中、晚孕期发生的比例为21.36%、22.69%、55.95%。DVT有27.9%(20.7-36.4%)发生于右腿。纳入的各研究间存在异质性，纳入的研究不存在发表偏倚。 结论：孕产妇VTE发生率和死亡率较同龄非孕产妇明显增加，临床医生应提高对妊娠相关VTE的警惕性。充分评估发病风险，对高危人群应采取及时的预防措施；高度疑诊或确诊患者应立即给予抗凝治疗。 背景：静脉血栓栓塞（venous thromboembolism，VTE），，包括深静脉血栓（deepvein thrombosis，DVT)和肺栓塞（pulmonary embolism，PE)。孕产妇是发生VTE的高危人群，发生率约为同龄非孕产妇的4-5倍。VTE的致死率和致残率较高，目前已成为孕产妇的主要死亡原因之一。 目的：了解孕产妇VTE的发生率，为孕产妇VTE的预防及治疗提供流行病学依据。 方法：对2011年8月至2012年8月期间首都医科大学附属北京朝阳医院产科住院分娩的孕妇进行前瞻性研究，所有研究对象均于产前一周内及产后出院前分别行一次双下肢超声检查以判断有无血栓。超声检查诊断DVT者需行CTPA检查以排除PE。提取研究对象的年龄、孕期体重增加值、合并症、分娩方式等基本信息。 结果：本研究共纳入322例孕产妇（其中174例剖宫产,148例阴道分娩），发现2例DVT患者，二者均发生于剖宫产后，未合并其他高危因素。2例DVT患者均未发生PE。 结论：孕产妇VTE发生率为6.21‰，剖宫产明显增加VTE风险，临床医生应提高对妊娠相关VTE的警惕性，尤其是剖宫产后妇女。
[Abstract]:Background: the incidence of venous thromboembolism (venous thromboembolism,VTE) increases during pregnancy and postpartum. The incidence of venous thromboembolism during pregnancy and postpartum has been counted in many literatures, but the reported incidence is quite different. Aim: to combine and synthesize the existing data by Meta analysis, and to obtain a relatively objective and stable result. Methods: the epidemiology of venous thromboembolism during pregnancy and postpartum was searched in PubMed, EMBase, CNKI and Wanfang database. According to the established inclusion / exclusion criteria, the retrieved documents are screened. The combined effect value and its 95% confidence interval (confidence interval,CI) were calculated by statistical software. Venous thromboembolism (deep vein thrombosis,DVT), deep venous thromboembolism (deep vein thrombosis,DVT), pulmonary embolism (pulmonary embolism,) The incidence of PE and the mortality of pulmonary embolism were combined with R software. The distribution of VTE in the prenatal and postpartum and the distribution of DVT in the left and right legs were combined in Beta3.13. The difference of postpartum incidence between VTE,DVT and PE was observed by subgroup analysis, the stability of the results was evaluated by sensitivity analysis, and publication bias was evaluated by Egger's test. Results: the incidence of VTE was 1.4 鈥

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