摘要
目的 探讨高龄经产妇剖宫产术后下肢深静脉血栓形成(DVT)发生的危险因素及预测指标。方法 选取2022年10月—2023年10月于永康市妇幼保健院就诊的180例高龄剖宫产产妇为研究对象,根据术后是否发生下肢DVT将其分为DVT组56例和非DVT组124例;对比两组经产妇临床资料、D-二聚体(D-D)、纤维蛋白原(Fib)、C-反应蛋白(CRP)水平;采用logistic回归分析高龄经产妇剖宫产后下肢DVT的危险因素,绘制受试者工作特性曲线(ROC)评估D-D、Fib及CRP对高龄经产妇剖宫产后下肢DVT的预测价值。结果 DVT组血清中D-D、Fib、CRP、Hcy及BNP水平[(4 028.40±423.36)μg/L、(5.34±0.68)g/L、(64.50±7.46)mg/L、(17.94±2.68)μmol/L、(624.50±69.46)pg/ml]均高于非DVT组[(381.78±40.32)μg/L、(3.28±0.52)g/L、(7.16±0.92)mg/L、(13.28±1.82)μmol/L、(367.16±70.92)pg/ml],差异有统计学意义(P<0.05)。年龄大于40岁、体质指数、妊娠期高血压疾病、妊娠糖代谢异常、未参加体育锻炼及D-D、Fib、CRP、Hcy及BNP水平升高均是高龄产妇剖宫产术后下肢DVT发生的危险因素(OR=3.133、1.445、3.367、2.499、6.160、4.162、10.135、8.423、7.737、5.171,P<0.05)。ROC曲线结果显示,Fib、Hcy、BNP对高龄产妇剖宫产术后下肢DVT具有较高的价值,AUC值均>0.90,且当各项指标的cut-off值分别取4.03 g/L、15.21μmol/L、531.37 pg/ml时,可获得最佳诊断价值。结论 高龄、体质指数、妊娠期高血压疾病、妊娠糖代谢异常、未参加体育锻炼及D-D、Fib、CRP、Hcy及BNP水平均是高龄产妇剖宫产术后发生下肢DVT的危险因素,血清CRP、Hcy及BNP水平可作为高龄产妇剖宫产术后发生下肢DVT较好的预测指标。
Objective To investigate the risk factors and predictors of lower extremity deep venous thrombosis(DVT)in elderly multiparas after cesarean section.Methods From October 2022 to October 2023,180 elderly multiparas who received cesarean section in the hospital were selected as the research subjects,and were divided into DVT group(56 case)and non-DVT group(124 case)according to whether lower extremity DVT occurred after surgery.The clinical data and levels of D-dimer(D-D),fibrinogen(Fib)and C-reactive protein(CRP)were compared between both groups.Logistic regression analysis was used to analyze the risk factors of lower extremity DVT in elderly multiparas after cesarean section.Receiver operating characteristic curve(ROC)was drawn to evaluate the predictive value of D-D,Fib and CRP on lower extremity DVT after cesarean section in elderly multiparas.Results Serum levels of D-D,Fib,CRP,Hcy and BNP in DVT group were(4028.40±423.36)μg/L,(5.34±0.68)g/L,(64.50±7.46)mg/L,(17.94±2.68)μmol/L,(624.50±69.46)pg/ml[(381.78±40.32)μg/L,(3.28±0.52)g/L,(7.16±0.92)mg/L,(13.28±1.82)μmol/L,(367.16±70.92)pg/ml] in the non-DVT group(P<0.05).Age greater than 40 years old,body mass index,gestational hypertension,abnormal glucose metabolism during pregnancy,no participation in physical exercise,and elevated levels of D-D,Fib,CRP,Hcy and BNP were all risk factors of lower extremity DVT after cesarean section in elderly multiparas(OR=3.133,1.445,3.367,2.499,6.160,4.162,10.135,8.423,7.737,5.171,all P<0.05).ROC curve results revealed that Fib,Hcy and BNP had high value on lower extremity DVT in elderly multiparas after cesarean section,and the AUC values were all>0.90.When the cut-off values of the above indexes were 4.03 g/L,15.21μmol/L and 531.37 pg/ml,the best diagnostic value could be obtained.Conclusion Advanced age,body mass index,gestational hypertension,abnormal glucose metabolism during pregnancy,no participation in physical exercise,D-D,Fib,CRP,Hcy and BNP levels are all risk factors of lower extremity DVT after cesarean section in elderly multiparas.Serum CRP,Hcy and BNP levels can be used as good predictors of lower extremity DVT in elderly multiparas after cesarean section.
作者
周文秀
李珺璐
周春燕
李燕燕
朱彬
ZHOU Wen-xiu;LI Jun-lu;ZHOU Chun-yan;LI Yan-yan;ZHU Bin(不详;Department of Obstetrics,Yongkang Maternal and Child Health Hospital,Yonghong,Zhejiang 321399,China)
出处
《中国妇幼保健》
2025年第14期2626-2629,共4页
Maternal and Child Health Care of China
基金
浙江省卫生健康科技计划项目(2021KY259)
浙江省永康市科技计划项目(202117)。
