摘要
目的分析孕妇分娩前后彩超暴风雪征联合凝血状态对产后下肢深静脉血栓(VTE)发生的预测效果。方法回顾性分析2014年1月—2018年10月期间本院分娩的246例产妇临床资料。根据产前1周和产后1周内下肢血管彩超暴风雪征和凝血异常,分别分为单次预测组(4次检查仅1次异常)73例、超声预测组(仅2次彩超暴风雪征)68例和联合预测组(4次检查任意2次异常)109例(其中包含超声预测组68例)。比较三组预测发生VTE情况,并比较预测的敏感度和特异度。另有64例孕妇上述检查结果均无异常。结果三组一般资料无明显差异,产后检查中联合预测组纤维蛋白原、D-二聚体水平、凝血因子活性显著高于超声预测组。246例患者实际发生VTE共44例(17.9%),联合预测组实际发生血栓38例,其中超声预测组21例血栓(30.9%);单次预测组3例血栓(4.1%);其余3例发生在4次检查均无异常的孕妇中。Kaplan-Meier法分析三组血栓形成存在差异(P<0.001)。其中联合预测组的敏感度(86.4%)和特异度(35.1%)均最高。结论围产期超声暴风雪征辅助诊断妊娠产妇血栓前状态、预测下肢深静脉血栓形成,具有较高的敏感性和特异性。
Objective To investigate the predictive performance of color Doppler ultrasonography combined with blood coagulation on the occurrence of postpartum deep venous thrombosis(VTE).Methods In this retrospective study,the clinical data of 246 parturients delivered between January 2014 and October 2018 were analyzed.According to the snowstorm sign(presence or absence)and coagulation status at 1 week before delivery and at 1 week postpartum,73 cases were divided into single prediction group(only one abnormality in either color Doppler ultrasound or coagulation status),68 cases into ultrasound prediction group(abnormalities in color Doppler ultrasound were identified both before delivery and postpartum),109 cases into combined prediction group(ultrasound abnormalities both before delivery and postpartum plus two abnormalities in coagulation status,and including 68 cases into ultrasound prediction group).The VTE occurrence was compared among the three groups,and the sensitivity and specificity of the prediction were also compared.In addition,there were 64 pregnant women with normal results.Results There was no significant difference in general characteristics among the three groups.The levels of FIB,D-dimer and coagulation factor activity in the combined prediction group were significantly higher than those in the ultrasound prediction group.There were 44 cases(17.9%)of VTE in 246 patients,including 38 cases of VTE in the combined prediction group,21 cases of VTE in the ultrasound prediction group(30.9%),3 cases of thrombosis in the single prediction group(4.1%)and 3 cases of normal pregnant women(4.7%).There were significant differences in the cumulative incidence of VTE among the three groups by Kaplan-Meier method(χ^2=22.836,P=0.000).The sensitivity(86.4%)and specificity(35.1%)of the combined prediction group were the highest.Conclusion Ultrasound snowstorm during perinatal period in combination with coagulation status has high sensitivity and specificity in assisting the diagnosis of prethrombotic state of pregnant w
作者
张文娟
王飞
苏玉美
邢小帅
孙博通
翟银伟
刘春影
Zhang Wenjuan;Wang Fei;Xing Xiaoshuai;Sun Botong;Zhai Yinwei;Liu Chunying(Chinese People′s Armed Police Force Characteristic Medical Center,Tianjin 300162,China)
出处
《中国生育健康杂志》
2019年第5期415-418,I0001,共5页
Chinese Journal of Reproductive Health
关键词
孕产妇
下肢深静脉血栓
彩色多普勒超声
Pregnant women
Deep venous thrombosis of lower extremities
Color Doppler ultrasound
