孕产妇孕产期静脉血栓栓塞风险评估的最佳证据总结

doi:10.16460/j.issn1008-9969.2022.03.046

摘要/Abstract

摘要： 目的获取国内外孕产妇孕产期相关静脉血栓风险评估的最佳证据,为构建评估工具提供参考依据。方法应用循证医学的方法,通过计算机检索Up To Data、BMJ、Cochrane Library、JBI、GIN、NCG、NICE、CMA、RNAO、PubMed、Embase、中国知网、万方数据库、中国生物医学数据库,选取符合纳入标准的相关文献,并通过2名研究员对文献进行独立的质量评价、证据提取及总结。结果共纳入文献12篇,其中包括临床实践指南6篇,高级临床决策1篇,系统评价5篇。从12篇文献中提取26条证据,最终整合形成4个维度,分别为既往因素（9条）、妊娠因素（4条）、产后因素（7条）和临时因素（6条）。结论基于循证证据总结孕产妇孕产期静脉血栓栓塞风险最佳证据,实现对孕产妇孕产期静脉血栓栓塞发生风险的动态评估,通过风险分层达到个体化风险管理的目的。

关键词: 妊娠期, 产褥期, 静脉血栓, 危险因素, 风险评估

Abstract: Objective To search the best evidence of risk assessment of venous thrombosis during pregnancy and puerperium at home and abroad, and to provide reference for the construction of assessment tool. Methods We searched databases including Up to Data, BMJ, Cochrane Library, JBI, GIN, NCG, NICE, CMA, RNAO, PubMed, Embase, CNKI, Wanfang database and China biomedical database by computer for literature meeting the inclusion criteria. Two researchers conducted independent quality evaluation, evidence extraction and summary of the literature. Results Twelve articles were enrolled, including 6 clinical practice guidelines, 1 advanced clinical decision and 5 systematic reviews. A total of 26 pieces of best evidence were integrated into 4 domains: previous factors (9 pieces of evidence), pregnancy-related factors (4 pieces of evidence) postpartum factors (7 pieces of evidence) and temporary factors (6 pieces of evidence). Conclusion The individualized risk assessment of venous thromboembolism in pregnant and puerperal women plays an important role in the prevention of pregnant and puerperal related thrombosis and provides evidence-based basis for clinical workers.

Key words: pregnancy, puerperium, venous thrombosis, risk factor, risk assessment

中图分类号:

R473.71

向御婷, 褚婕, 严敏, 乐曲, 余嘉欣. 孕产妇孕产期静脉血栓栓塞风险评估的最佳证据总结[J]. 护理学报, 2022, 29(3): 46-51.

XIANG Yu-ting, CHU Jie, YAN Min, LE Qu, YU Jia-xin. Best Evidence Summary of Risk Assessment of Venous Thromboembolism during Pregnancy and Puerperium[J]. Journal of Nursing, 2022, 29(3): 46-51.

参考文献

[1] 马信龙,张建敏,马剑雄,等.骨科大手术后静脉血栓栓塞症的研究进展[J]. 中华骨科杂志, 2016, 36(15):995-1001. DOI:10.3760/cma.j.issn.0253-2352.2016.15.007.
[2] Malhotra A, Weinberger SE.Deep Vein Thrombosis in Pregnancy: Epidemiology, Pathogenesis,Diagnosis[EB/OL].(2019-09-19)[2020-06-16]. https://www.uptodate.com/contents/zh-Hans/pulmonary-embolism-in-pregnancy-epidemiology-pathogenesis-and-diagnosis?search=Deep%20vein%20thrombosis%20in%20pregnancy:%20Epidemiology,%20pathogenesis,%20and%20diagnosis&topicRef=1349&source=see_link.
[3] Kujovich JL.Hormones and Pregnancy:Thromboembolic Risks for Women[J]. Br J Haematol, 2015, 126(4):443-454. DOI:10.1111/j.1365-2141.2004.05041.x.
[4] Chang J, Elam-Evans LD, Berg CJ, et al.Pregnancy-related Mortality Surveillance—United States,1991—1999[J]. MMWR Surveill Summ, 2003, 52(2):1-8. DOI:Pregnancy-relatedMortalitySurveillance—UnitedStates,1991—1999[J].MMWRSurveillSumm,2003,52(2):1-8.DOI:http://dx.doi.org/.
[5] Bourjeily G, Paidas M, Khalil H, et al.Pulmonary Embolism in Pregnancy[J]. Lancet, 2010, 375(9713):500-512. DOI:10.1016/s0140-6736(09)60996-x.
[6] Okoroh EM, Azonobi IC, Grosse SD, et al.Prevention of Venous Thromboembolism in Pregnancy: A Review of Guidelines, 2000-2011[J]. J Womens Health, 2012, 21(6):611-615. DOI:10.1089/jwh.2012.3600.
[7] Royal College of Obstetricians and Gynaecologists. Reducing the Risk of Venous Thromboembolism during Pregnancy and the Puerperium(Green-top Guideline No 37a)[EB/OL]. (2015-04-13)[2021-02-15].https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg37a/.
[8] Linnemann B, Bauersachs R, Rott H, et al.Diagnosis of Pregnancy-associated Venous Thromboembolism-position Paper of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH)[J]. Vasa, 2016, 45(2):87-101. DOI:10.1024/0301-1526/a000503.
[9] Bates SM, Middeldorp S, Rodger M, et al.Guidance for the Treatment and Prevention of Obstetric-associated Venous Thromboembolism[J]. J Thromb Thrombolysis, 2016, 41(1):92-128. DOI:10.1007/s11239-015-1309-0.
[10] James AH.Thrombosis in Pregnancy and Maternal Outcomes[J]. Birth Defects Res C Embryo Today, 2015,105(3):159-166. DOI:10.1002/bdrc.21106.
[11] Kearon C, Akl EA, Comerota AJ, et al.Antithrombotic Therapy for VTE Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-based Clinical Practice Guidelines[J]. Chest, 2012, 141(2):e419S-e496S. DOI:10.1378/chest.11-2301.
[12] 左红霞,牛玉明,程艳丽.循证护理证据资源的检索[J].循证护理,2015,1(4):145-151.DOI:10.3969/j.issn.2095-8668.2015.04.001.
[13] 谢利民,王文岳.《临床指南研究与评价系统Ⅱ》简介[J].中西医结合学报,2012,10(2):160-165.DOI:10.3736/jcim20120206.
[14] 朱丽群,庄若,曹松梅,等. PICC相关性血栓风险评估的最佳证据总结[J].中华护理杂志, 2017, 52(10):1179-1185. DOI:10.3761/j.issn.0254-1769.2017.10.005.
[15] 王春青,胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967. DOI:10.16821/j.cnki.hsjx.2015.11.002.
[16] 王亚玲,王冰寒,张艳,等. 急性缺血性脑卒中患者溶栓术后预防出血转化的最佳证据总结[J].护理学报, 2021, 28(3):46-52. DOI:10.16460/j.issn1008-9969.2021.03.046.
[17] 严玉娇,丁娟,刘晁含,等.成人危重症患者气道管理的最佳证据总结[J].护理学报, 2021, 28(3):39-45.DOI:10.16460/j.issn1008-9969.2021.03.039.
[18] Bates SM, Greer IA, Middeldorp S, et al.VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-based Clinical Practice Guidelines[J]. Chest,2012:e691S-e736S.
[19] Kearon C, Akl EA, Ornelas J, et al.Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report[J].Chest,2016,149(2):315-352.DOI:10.1016/j.chest.2015.11.026.
[20] Bates SM, Rajasekhar A, Middeldorp S, et al.American Society of Hematology 2018 Guidelines for Management of Venous Thromboembolism: Venous Thromboembolism in the Context of Pregnancy[J]. Blood Adv, 2018, 2(22): 3317-3359. DOI:10.1182/bloodadvances.2018024802.
[21] Chan WS, Rey E, Kent NE, et al.Venous Thromboembolism and Antithrombotic Therapy in Pregnancy[J].J Obstet Gynaecol Can, 2014, 36(6):527-553. DOI:10.1016/s1701-2163(15)30569-7.
[22] Romero A, Alonso C, Rincon M, et al.Risk of Venous Thromboembolic Disease in Women a Qualitative Systematic Review[J]. Eur J Obstet Gynecol Reprod Biol, 2005, 121(1):8-17. DOI:10.1016/j.ejogrb.2004.11.023.
[23] Croles FN, Nasserinejad K, Duvekot JJ, et al.Pregnancy, Thrombophilia, and the Risk of a First Venous Thrombosis: Systematic Review and Bayesian Meta-analysis[J]. BMJ, 2017, 359:j4452. DOI:10.1136/bmj.j4452.
[24] Biron-Andreani C, Schved JF, Daures JP.Factor V Leiden Mutation and Pregnancy-related Venous Thromboembolism: What Is the Exact Risk? Results from a Meta-analysis[J]. Thromb Haemost, 2006, 96(1):14-18. DOI:10.1160/TH06-02-0086.
[25] Kim YH, Pfaller B, Marson A, et al.The Risk of Venous Thromboembolism in Women with Inflammatory Bowel Disease During Pregnancy and the Postpartum Period: A Systematic Review and Meta-analysis[J]. Medicine (Baltimore),2019,98(38):e17309.DOI:10.1097/MD.0000000000017309.
[26] Kemmeren JM, Algra A, Grobbee DE.Third Generation Oral Contraceptives and Risk of Venous Thrombosis: Meta-analysis[J]. BMJ, 2001, 323(7305):131-134. DOI:10.1136/bmj.323.7305.131.
[27] Robertson L, Wu O, Langhorne P, et al.Thrombophilia in Pregnancy:A Systematic Review[J]. Br J Haematol, 2006, 132(2):171-196. DOI:10.1111/j.1365-2141.2005.05847.x.
[28] He R, O'connell Cm, Ks J, et al.Maternal Outcomes in Pregnancies Complicated by Obesity[J]. Obstet Gynecol, 2005,106(6):1357-1364.DOI:10.1097/01.AOG.0000188387.88032.41.
[29] Larsen TB, Sørensen HT, Gislum M, et al.Maternal Smoking, Obesity, and Risk of Venous Thromboembolism During Pregnancy and the Puerperium: A Population-based Nested Case-control Study[J]. Thromb Res, 2007, 120(4):505-509. DOI:10.1016/j.thromres.2006.12.003.
[30] Pabinger I, Grafenhofer H, Pa K, et al.Temporary Increase in the Risk for Recurrence During Pregnancy in Women with a History of Venous Thromboembolism[J].Blood, 2002, 100(3):1060-1062. DOI:10.1182/blood-2002-01-0149.
[31] 李东繁,杜旭升,刘安. Padua风险评估模型在慢性阻塞性肺疾病急性加重期患者并发静脉血栓栓塞疾病预防中的作用[J]. 陕西医学杂志, 2016, 45(11):1509-1510. DOI:10.3969/j.issn.1000-7377.2016.11.028.
[32] 陶俊荣,宋红霞. Padua风险评估模型在预防内科住院患者静脉血栓栓塞症中的应用[J].中国实用护理杂志, 2018, 34(32):2496-2501.DOI:10.3760/cma.j.issn.1672-7088.2018.32.004.
[33] Pannucci CJ,Swistun L, Macdonald JK, et al.Individualized Venous Thromboembolism Risk Stratification Using the 2005 Caprini Score to Identify the Benefits and Harms of Chemoprophylaxis in Surgical Patients: A Meta-analysis[J]. Ann Surg, 2017, 265(6):1094-1103. DOI:10.1097/SLA.0000000000002126.
[34] 徐留海,曾勇,黄卫,等.基于Caprini血栓风险模型评估膝关节镜手术患者深静脉血栓形成的风险性[J]. 中国组织工程研究, 2016, 20(17):24434-24440. DOI:10.3969/j.issn.2095-4344.2016.17.006.
[35] Knight M.Antenatal Pulmonary Embolism: Risk Factors, Management and Outcomes[J]. BJOG, 2008, 115(4):453-461. DOI:10.1111/j.1471-0528.2007.01622.x.
[36] Steegers EA, Von Dadelszen P, Duvekot JJ, et al.Pre-eclampsia[J]. Lancet, 2010, 376(9741):631-644. DOI:10.1016/s0140-6736(10)60279-6.
[37] Sheppard BL, Bonnar J.An Ultrastructural Study of Utero-placental Spiral Arteries in Hypertensive and Normotensive Pregnancy and Fetal Growth Retardation[J]. Br J Obstet Gynaecol, 1981, 88(7):695-705. DOI:10.1111/j.1471-0528.1981.tb01268.x.
[38] Lindqvist P, Dahlbäck B, Marŝál K. Thrombotic Risk During Pregnancy: A Population Study[J]. Obstet Gynecol, 1999, 94(4):595-599. 10.1016/s0029-7844(99)00308-7.
[39] Jacobsen AF,Skjeldestad FE, Sandset PM.Ante- and Postnatal Risk Factors of Venous Thrombosis:A Hospital-based Case-control Study[J]. J Thromb Haemost, 2008, 6(6): 905-912. DOI:10.1111/j.1538-7836.2008.02961.x.
[40] Sultan AA, Tata LJ, West J, et al.Risk Factors for First Venous Thromboembolism Around Pregnancy: A Population-based Cohort Study from the United Kingdom[J]. Blood, 2013,121(19):3953-3961.DOI:10.1182/blood-2012-11-469551.
[41] Liu S, Liston RM, Joseph KS, et al.Maternal Health Study Group of the Canadian Perinatal Surveillance System. Maternal Mortality and Severe Morbidity Associated with Low-risk Planned Cesarean Delivery Versus Planned Vaginal Delivery at Term[J]. Obstetrical & Gynecological Survey, 2007,62(8):499-500.DOI:10.1097/01.ogx.0000271111.20802.e0.
[42] Caprini JA,Arcelus JI, Hasty JH, et al.Clinical Assessment of Venous Thromboembolic Risk in Surgical Patients[J]. Semin Thromb Hemost, 1991,17(Suppl 3):304-312.DOI:10.1055/s-2007-1002590.

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