【摘要】：背景：靜脈血栓栓塞（venous thromboembolism，VTE）的發(fā)生率在孕期和產(chǎn)后有所增加。已有很多文獻(xiàn)對(duì)靜脈血栓栓塞在孕期和產(chǎn)后的發(fā)生率進(jìn)行了統(tǒng)計(jì)，然而所報(bào)道的發(fā)生率有很大差異。 目的：本研究旨在通過Meta分析的方法對(duì)既有的相關(guān)研究進(jìn)行數(shù)據(jù)合并與綜合，進(jìn)而得到一個(gè)相對(duì)客觀和穩(wěn)定的結(jié)果。 方法：檢索PubMed, EMBase, CNKI和萬方數(shù)據(jù)庫中關(guān)于孕期和產(chǎn)后靜脈血栓栓塞流行病學(xué)的研究。根據(jù)己擬定的納入/排除標(biāo)準(zhǔn)對(duì)檢索到的文獻(xiàn)進(jìn)行篩選。使用統(tǒng)計(jì)軟件計(jì)算合并效應(yīng)值及其95%可信區(qū)間（confidence interval，CI）。靜脈血栓栓塞、深靜脈血栓（deep vein thrombosis，DVT)、肺栓塞（pulmonary embolism，PE)的發(fā)生率和肺栓塞的死亡率的合并使用R軟件。VTE在產(chǎn)前產(chǎn)后的分布以及DVT在左右腿的分布情況在Beta3.13中進(jìn)行合并。通過亞組分析觀察VTE、DVT和PE在產(chǎn)后發(fā)生率的差異，進(jìn)行敏感性分析對(duì)結(jié)果的穩(wěn)定性進(jìn)行評(píng)價(jià)，使用Egger's檢驗(yàn)評(píng)估發(fā)表偏倚。 結(jié)果：我們共納入27篇研究，VTE發(fā)生率為1.4‰(1.0-1.8‰)，DVT發(fā)生率為1.1‰(1.0-1.3‰), PE發(fā)生率為0.3‰(0.2-0.4‰), PE死亡率為6.58%(3.30-13.09%)。VTE在產(chǎn)后的發(fā)生比例為57.5%(50.9-63.9%)，VTE在早、中、晚孕期發(fā)生的比例為21.36%、22.69%、55.95%。DVT有27.9%(20.7-36.4%)發(fā)生于右腿。納入的各研究間存在異質(zhì)性，納入的研究不存在發(fā)表偏倚。 結(jié)論：孕產(chǎn)婦VTE發(fā)生率和死亡率較同齡非孕產(chǎn)婦明顯增加，臨床醫(yī)生應(yīng)提高對(duì)妊娠相關(guān)VTE的警惕性。充分評(píng)估發(fā)病風(fēng)險(xiǎn)，對(duì)高危人群應(yīng)采取及時(shí)的預(yù)防措施；高度疑診或確診患者應(yīng)立即給予抗凝治療。 背景：靜脈血栓栓塞（venous thromboembolism，VTE），，包括深靜脈血栓（deepvein thrombosis，DVT)和肺栓塞（pulmonary embolism，PE)。孕產(chǎn)婦是發(fā)生VTE的高危人群，發(fā)生率約為同齡非孕產(chǎn)婦的4-5倍。VTE的致死率和致殘率較高，目前已成為孕產(chǎn)婦的主要死亡原因之一。 目的：了解孕產(chǎn)婦VTE的發(fā)生率，為孕產(chǎn)婦VTE的預(yù)防及治療提供流行病學(xué)依據(jù)。 方法：對(duì)2011年8月至2012年8月期間首都醫(yī)科大學(xué)附屬北京朝陽醫(yī)院產(chǎn)科住院分娩的孕婦進(jìn)行前瞻性研究，所有研究對(duì)象均于產(chǎn)前一周內(nèi)及產(chǎn)后出院前分別行一次雙下肢超聲檢查以判斷有無血栓。超聲檢查診斷DVT者需行CTPA檢查以排除PE。提取研究對(duì)象的年齡、孕期體重增加值、合并癥、分娩方式等基本信息。 結(jié)果：本研究共納入322例孕產(chǎn)婦（其中174例剖宮產(chǎn),148例陰道分娩），發(fā)現(xiàn)2例DVT患者，二者均發(fā)生于剖宮產(chǎn)后，未合并其他高危因素。2例DVT患者均未發(fā)生PE。 結(jié)論：孕產(chǎn)婦VTE發(fā)生率為6.21‰，剖宮產(chǎn)明顯增加VTE風(fēng)險(xiǎn)，臨床醫(yī)生應(yīng)提高對(duì)妊娠相關(guān)VTE的警惕性，尤其是剖宮產(chǎn)后婦女。
[Abstract]:Background: the incidence of venous thromboembolism (venous thromboembolism,VTE) increases during pregnancy and postpartum. The incidence of venous thromboembolism during pregnancy and postpartum has been counted in many literatures, but the reported incidence is quite different. Aim: to combine and synthesize the existing data by Meta analysis, and to obtain a relatively objective and stable result. Methods: the epidemiology of venous thromboembolism during pregnancy and postpartum was searched in PubMed, EMBase, CNKI and Wanfang database. According to the established inclusion / exclusion criteria, the retrieved documents are screened. The combined effect value and its 95% confidence interval (confidence interval,CI) were calculated by statistical software. Venous thromboembolism (deep vein thrombosis,DVT), deep venous thromboembolism (deep vein thrombosis,DVT), pulmonary embolism (pulmonary embolism,) The incidence of PE and the mortality of pulmonary embolism were combined with R software. The distribution of VTE in the prenatal and postpartum and the distribution of DVT in the left and right legs were combined in Beta3.13. The difference of postpartum incidence between VTE,DVT and PE was observed by subgroup analysis, the stability of the results was evaluated by sensitivity analysis, and publication bias was evaluated by Egger's test. Results: the incidence of VTE was 1.4 鈥

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