妇产科术后静脉血栓栓塞症病例分析-妇产科学专业论文.docxVIP

PAGE PAGE 4 妇产科术后静脉血栓栓塞症病例分析 摘 要 目的：探讨妇产科术后发生深静脉血栓栓塞症（VTE）的危险因素，提高对高危患 者的认识，为临床上预防术后 VTE 提供参考。 方法：回顾性分析 2005-2010 年福建医科大学附属第一医院因深静脉血栓栓塞症 （VTE）且在近半年内有妇产科手术史的住院病例共 54 例，分析其术后发生 VTE 的 时间；并以近 1 年妇科手术病例为对照，分析年龄、手术方式、前患病种的构成与 VTE 的关系；以病例对照形式分别收集妇科术后与分娩后发生 VTE 病例的对照组， 分析基本血液生化参数与血栓发生的关系。 结果：妇产科术后 VTE 多发生于术后 1 月内，但妇科术后的发病时间相对的早于产 科。发生血栓组与妇科住院病人相比，恶性肿瘤所占比例较高，年龄差异具有统计 学意义，腹腔镜手术并不增加 VTE 的风险。血栓组血浆相对性的出现 Fib 增高、HDL-C 降低，分别为 4.19±1.28g/L 和 1.11±0.23mmol/L。妊娠期 Hb、Hct、PLT 降低， 而 Fib、TC、TG、HDL-C、LDL-C 均升高。与剖宫产患者相比，剖宫产血栓组 Hct 增 高而 TC、TG、HDL-C 降低。 结论：VTE是妇产科围手术期的严重并发症之一，妇产科手术是发生VTE的危险因 素。40-59岁年龄段、恶性肿瘤增加VTE风险，而腹腔镜手术并不增加VTE的风险， 患者血浆高Fib是术后VTE发生的危险因素，而HDL-C是其保护因素；术后14天内是 血栓的好发期，妊娠或产褥状态可延长发病的危险时间。妊娠及产褥期高Fib、血 脂均增加发生VTE危险。 【关键词】妇产科手术 静脉血栓栓塞症 危险因素 手术并发症 Cases analysis on postoperative venous thromboembolism in the department of obstetrics and gynecology Abstract Objective：we explored the risk factors of postoperative venous thromboembolism (VTE) in the department of obstetrics and gynecology, for distinguishing the high-risk patients, also offering help with preventing patients from receiving VTE. Methods：A Retrospective analyze of time was carried on 54 cases with VTE, who hospitalized because of thrombosis and had a history of obstetrics and gynecology operation in half year, from 2005 to 2010 in the First Affiliated Hospital of Fujian Medical University Then, cases with gynecological surgery nearly one year were compared with it about the composition of primary disease and surgical approaches. Whats more, we analyzed the relation between VTE with basic blood biochemical parameters by collecting the control cases of VTE after gynecological surgery or childbirth in a case-control form separately. Result：Postoperative VTE occurred more often in 1 months, but in relative terms ， gynecologic was earlier than obstetrical. When comparing hospitalized gynecological patients with VTE patients, the latter had a higher proportion in cancer and there was a statistically significant difference in