摘要
目的 评价低分子肝素(LMWH)在剖宫产产妇静脉血栓栓塞症(VTE)预防中的有效性与安全性,并分析影响疗效的相关因素。方法 回顾性纳入2023年8月至2025年8月行剖宫产的125例产妇,随访2个月。按术后是否使用LMWH分为LMWH组与未用LMWH组,比较深静脉血栓形成(DVT)及出血发生率,并在LMWH组内按首次用药时间和连续用药天数分层。收集人口学特征、高危因素、实验室指标变化并进行单因素及多因素分析。结果 LMWH组DVT发生率显著低于未用LMWH组[15.05% vs 59.38%,P<0.001],且未增加出血风险。多因素Logistic回归显示,LMWH的使用与较低的DVT风险独立相关(调整后的OR=0.163,95%CI:0.049~0.544,P=0.003),而既往血栓史是最强危险因素(P<0.001)。首次用药时间对DVT和出血无显著影响;疗程>14 d DVT发生率反而升高(P<0.001)。纤维蛋白原变化量与DVT风险相关(P=0.009)。结论 预防性应用LMWH可显著降低剖宫产产妇DVT发生率,其保护作用在校正基线差异后依然稳健。既往血栓史患者风险最高,应重点关注。结合风险分层与凝血指标动态监测可优化个体化抗凝策略。
Objective To evaluate the efficacy and safety of low-molecular-weight heparin(LMWH)in preventing venous thromboembolism(VTE)after cesarean section,and to analyze factors influencing therapeutic outcomes.Methods Totally 125 women who underwent cesarean section between August 2023 and August 2025 were retrospectively studied and followed for two months.According to postoperative LMWH administration,patients were divided into an LMWH group and a non-LMWH group.The incidence of deep vein thrombosis(DVT)and bleeding events was compared between both groups.In the LMWH group,subgroup analyses were performed based on the timing of initial administration and the duration of continuous treatment.Demographic characteristics,high-risk factors,and laboratory parameter changes were analyzed using univariate and multivariate analyses.Results The incidence of DVT was significantly lower in the LMWH group than that in the non-LMWH group[15.05%vs 59.38%,P<0.001],with no increase in bleeding risk.Multivariate Logistic regression demonstrated that LMWH use was independently associated with a reduced risk of DVT(adjusted OR=0.163,95%CI:0.049~0.544,P=0.003),while history of thrombosis was identified as the strongest independent risk factor(P<0.001).The timing of initial LMWH administration did not obviously affect DVT or bleeding,whereas a treatment duration of>14 days was associated with a higher DVT incidence(P<0.001).Changes in the fibrinogen levels were also associated with DVT risk(P=0.009).Conclusion Prophylactic LMWH greatly reduces the incidence of DVT after the cesarean section,whose protective effect remains robust after adjustment for baseline differences.A history of thrombosis confers the highest risk and requires special attention.Combining clinical risk stratification with dynamic monitoring of coagulation parameters may help optimize individualized anticoagulation strategies.
作者
温娟清
熊慧婷
唐子轩
冯小轩
周伯庭
彭麒霖
WEN Juanqing;XIONG Huiting;TANG Zixuan;FENG Xiaoxuan;ZHOU Boting;PENG Qilin(Department of Obstetrics and Gynecology,Ruijin Maternal and Child Health Hospital,Ruijin Jiangxi 342500;School of Pharmacy,Hubei University of Science and Technology,Xianning Hubei 437100;Department of Pharmacy,Xiangya Hospital of Central South University,Changsha 410008;School of Basic and Clinical Pharmacy,China Pharmaceutical University,Nanjing 211100;Department of Neurology,Xiangya Hospital of Central South University,Changsha 410008)
出处
《中南药学》
2025年第12期3701-3707,共7页
Central South Pharmacy
基金
湖南省自然科学基金(No.2022JJ30989)。
关键词
剖宫产
低分子肝素
静脉血栓栓塞症
深静脉血栓
抗凝治疗
cesarean section
low-molecular-weight heparin
venous thromboembolism
deep vein thrombosis
anticoagulant therapy
