RCOG血栓风险评估模型在产妇静脉血栓栓塞症中的预防价值

摘要

Objective: To explore the application of the RCOG (Royal College of Obstetricians and Gynaecologists) model of thrombosis risk assessment in the prevention of maternity venous thromboembolism (VTE). Methods: A total of 2 089 puerperas delivered in our hospital were included from May 2015 to June 2016. They were randomly divided into the control group and the observation group. Puerperas in the control group were treated by traditional nursing to prevent VTE. Based on the RCOG model, those puerperas in the observation group were classified and treated by corresponding intervention. The levels of prenatal and postnatal blood D-dimer in two groups, and the morbidity of VTE, were compared. Results:There was not significant difference in the level of prenatal blood D-dimer between two groups (P>0.05). The level and the positive rate of postnatal D-dimer in the observation group were significantly lower than those in the control group (P<0.05). The ratio of puerperas with the increased postnatal D-dimer level in the observation group was much lower than that in the control group (P<0.05). No puerpera in the observation group had VTE during the 6-week follow-up period, while 4 puerperas with the high VTE risk in the control groups had VTE, who were classified into the high risk or highest risk group following RCOG assessment model. The morbidity of VTE in the control group was higher than it in the observation group, but the difference was not significant (P>0.05). Conclusions:The RCOG model of thrombosis risk assessment was effective in the classification of puerperas VTE risk, the decreased D-dimer level, and the prevention of VTE by corresponding intervention.%目的：探究英国皇家妇产科医师学会（RCOG）发布的血栓风险评估模型对产妇静脉血栓栓塞症的预防价值。方法：收集2015年5月—2016年6月在广东省东莞市长安医院产科分娩的产妇2089名，随机分为对照组和研究组。对照组产妇予以常规护理方法预防静脉血栓栓塞症；研究组产妇采用RCOG血栓风险评估模型进行分级，并采取相应的干预措施。比较2组患者产前、产后血浆D-二聚体变化情况以及静脉血栓栓塞症发生情况。结果：2组产妇产前D-二聚体水平差异无统计学意义（P＞0.05）。研究组产后D-二聚体水平及D-二聚体阳性率均低于对照组，差异有统计学意义（P＜0.05）。研究组产后D-二聚体较产前升高者的比例明显低于对照组，差异有统计学意义（P＜0.05）。随访6周内研究组中无产妇产后发生静脉血栓栓塞症，而对照组有4名产妇发生静脉血栓栓塞症，且RCOG分级均处于高危或以上级别，研究组的静脉血栓栓塞症发生率比对照组低，但差异无统计学意义（P＞0.05）。结论：采用RCOG血栓风险评估模型对产妇进行血栓风险分级并予以相应预防性治疗能够有效降低产妇产后D-二聚体水平，减少静脉血栓栓塞症的发生风险，具有一定的临床预测和预防价值。