摘要
目的:研究Caprini模型在预测高龄产妇产后静脉血栓栓塞症(venous thromboembolism,VTE)中的有效性及临床价值.方法:通过病例回顾性研究方法,选择2020年1月—2023年10月在本院生产且产后确诊为VTE的35例高龄产妇作为观察组,产后没有出现VTE的70例作为对照组.收集两组患者的各项临床资料,然后采用Caprini静脉血栓风险预测模型对两组患者进行各项风险条目评分,通过t检验比较两组间Caprini评分差异,并通过卡方检验及Logistic回归分析方法评估该模型下各项危险因素及危险分层情况,从而分析模型中产后VTE的独立危险因素,以及危险分层与VTE发生风险之间的关系.结果:观察组患者Caprini平均分值显著高于对照组.单因素分析结果显示,两组患者在卧床时间、肺功能异常情况、VTE家族史、流产史(包括不明原因或习惯性)、炎症性肠病史、腹腔镜手术6个因素比较无明显差异;观察组患者在年龄大于40岁、留置中心静脉通路、小手术、大型开放手术、腿肿胀、静脉曲张、VTE疾病史7个因素的占比均显著高于对照组;两组患者在BMI、严重肺病、恶性肿瘤、口服避孕药或雌激素、妊娠或产后1个月等5个因素不具备可比性价值.Logistic分析结果显示,留置中心静脉通路、腿肿胀、静脉曲张是高龄产妇发生VTE的独立风险因素.结论:Caprini静脉血栓风险预测模型可以有效对高龄产妇围产期进行VTE风险分层,当患者有留置中心静脉通路、腿肿胀、静脉曲张情况,预示高龄产妇围产期发生VTE风险显著增加,研究为高龄产妇围产期VTE的防治提供了新的科学线索.
Abstract
Objective To investigate the validity and clinical value of Caprini model in predicting the occurrence of venous thromboembolism(VTE)in advanced maternal age(AMA).Methods A retrospective case study was conducted to select 35 AMAs born in our center from January 2020 to October 2023 with postpartum diagnosis of VTE as the obervation group,and 70 AMAs born in our center during the same period with postpartum diagnosis of non-VTE as the control group according to the principle of 1:2.Various clinical data of the two groups of patients were collected,and then the Caprini venous thrombosis risk prediction model was used to score various risk items for the two groups of patients.The differences in Caprini score between the two groups were compared by T-test,and the risk factors and risk stratification under this model were evaluated by Chi-square test and Logistic regression analysis.The independent risk factors of postpartum VTE and the relationship between risk strati-fication and the risk of VTE were analyzed.Results The average Caprini score of the observation group was significantly higher than that of the control group.Based on the single factor analysis of Caprini model entries,there is no statistically significant difference in six factors:bed time,abnormal lung function,family history of VTE,history of abortion(including unknown cause or habitual),history of inflammatory bowel,and laparoscopic surgery;Patients in the observation group had a higher propor-tion in age over 40 years old,central venous access indentation,minor surgery,major open surgery,leg swelling,varicose veins,and history of VTE disease;The observation and control groups were not comparable in terms of BMI,severe lung disease,malignancy,oral contraceptives or estrogen,and pregnancy or 1 month postpartum.Logistic analysis results showed that indent-able central venous access,leg swelling,and varicose veins were independent risk factors for VTE in advanced maternal age.Conclusion Caprini venous thrombosis risk prediction model can effectively stratification the perinatal risk of VTE in elderly women.When patients have central venous access indentation,leg swelling,and varicose veins,it indicates that the risk of peri-natal VTE in elderly women will increase significantly,this study provides a new scientific clue for the prevention and treatment of perinatal VTE in advanced maternal age.
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