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目的分析分娩方式与产后下肢深静脉血栓形成(DVT)的关系并探讨其治疗方法。方法回顾性分析我院48例产后下肢DVT患者的临床资料。结果 2006年7月至2012年4月期间住院分娩总数15 897例,其中剖宫产10 097例(63.52%),发生下肢DVT 41例(0.41%);顺产5 800例(36.48%),发生下肢DVT 7例(0.12%)。剖宫产后下肢DVT发生率明显高于顺产(χ2=9.94,P<0.005)。每年的剖宫产例数和下肢DVT发生情况之间呈正相关(rs=0.87,P<0.05),即剖宫产率越高,下肢DVT发生率越高。48例下肢DVT患者均治愈出院,其中43例仅药物治疗,2例手术和药物结合治疗,3例采用气压梯度结合抗凝治疗,5例下腔静脉滤器置入结合药物治疗。结论剖宫产妇女下肢DVT的发生率较顺产者高,溶栓及抗凝疗法是治疗下肢DVT的有效方法,严格掌握剖宫产手术指征及产后尽早下床活动可减少DVT发生。
Objective To analyze the relationship between mode of delivery and postpartum deep vein thrombosis (DVT) and discuss its treatment. Methods Retrospective analysis of 48 cases of postpartum DVT in our hospital clinical data. Results A total of 15 897 hospital deliveries between July 2006 and April 2012 were found, among which 10 097 (63.52%) were cesarean and 41 (0.41%) DVT occurred in lower extremities; 5 800 (36.48%) were spontaneous Lower extremity DVT in 7 cases (0.12%). The incidence of DVT in lower extremities after cesarean section was significantly higher than that in the first trimester (χ2 = 9.94, P <0.005). There was a positive correlation between the number of cases of cesarean section and the incidence of DVT in lower extremities (rs = 0.87, P <0.05). That is, the higher the rate of cesarean section, the higher the incidence of DVT in lower extremities. Forty-eight patients with lower extremity DVT were cured and discharged. Among them, 43 patients were treated with drugs only, 2 patients were treated with drugs and drugs, 3 patients were treated with pressure gradient combined with anticoagulant therapy, and 5 patients with inferior vena cava filter were treated with drugs. Conclusions The incidence of DVT in lower extremities of women with cesarean section is higher than that of those in normal subjects. Thrombolysis and anticoagulant therapy are effective methods for the treatment of lower extremity DVT. Strict control of cesarean section indications and early mobilization after delivery can reduce the incidence of DVT.