孕产妇静脉血栓栓塞症预防与管理的最佳证据总结

doi:10.3761/j.issn.1672-9234.2021.06.016

摘要/Abstract

摘要：

目的总结孕产妇静脉血栓栓塞症预防与管理的最佳证据。方法检索UpToDate、Cochrane Library、JBI、PubMed、中国知网、万方等数据库以及美国妇产科医师协会、英国国家卫生与临床优化研究所、英国皇家妇产科医师学会等网站中有关孕产妇静脉血栓栓塞症预防与管理的证据,检索时限为建库至2019年12月。2名研究者采用指南研究与评价工具（AGREE Ⅱ）和澳大利亚JBI循证卫生保健中心的标准对文献进行质量评价,并进行证据提取。结果共纳入文献14篇,包括指南7篇、系统评价2篇、专家共识3篇、证据总结1篇、最佳实践信息册1篇,最终获取了25条最佳证据,包括风险评估、预防措施、管理策略、健康教育4个方面。结论本研究总结了孕产妇静脉血栓栓塞症预防与管理的最佳证据,为临床管理者提供循证依据,保证孕产妇安全。

关键词: 孕妇, 静脉血栓栓塞, 循证护理学

Abstract:

Objective To summary the best evidences for prevention and management of venous thromboembolism in pregnant women. Methods We searched the literatures on the prevention and management of maternal venous thromboembolism in the following databases：UpToDate,Cochrane Library,JBI,PubMed,CNKI,Wanfang Database,American College of Obstetricians and Gynecologists,National Institute for Health and Care Excellence,the Royal College of Obstetricians and Gynaecologists,etc. The search time limit was from database inception to December 2019.Two researchers used AGREE Ⅱ and the standards of the Australian JBI Evidence-based Health Care Center to evaluate the quality of the literature and conduct data extraction. Results A total of fourteen references were included,and they were seven clinical practice guidelines,two systematic reviews,three expert consensuses,one evidence summary,and one best practice information sheet. Twenty-five pieces of best evidence were obtained,including risk assessment,prevention measures,management strategy and health education. Conclusion This study summarizes the best evidences for the prevention and management of venous thromboembolism in pregnant women,and provides evidence for clinical managers to ensure maternal safety.

Key words: Pregnant Women, Venous Thromboemlism, Evidence-Based Nursing

耿小婷,李淑英,王春华,刘俊英,张延红,陈亚静,王诗翔. 孕产妇静脉血栓栓塞症预防与管理的最佳证据总结[J]. 中华护理教育, 2021, 18(6): 556-561.

GENG Xiao-ting,LI Shu-ying,WANG Chun-hua,LIU Jun-ying,ZHANG Yan-hong,CHEN Ya-jing,WANG Shi-xiang. Evidence summary for prevention and management of venous thromboembolism in pregnant women[J]. Chinese Journal of Nursing Education, 2021, 18(6): 556-561.

图/表 3

参考文献 27

[1]	王琳. Autar和Caprini深静脉血栓形成风险评估表在ICU的应用效果比较[J]. 全科护理, 2019,17(3):267-269.
	Wang L. Comparison of the application of Autar and Caprini deep vein thrombosis risk assessment in ICU[J]. Chin Gen Pract Nurs, 2019,17(3):267-269.
[2]	赵鹏, 蔺莉, 栾景源, 等. 妊娠及产褥期静脉血栓栓塞的危险因素评估及处理策略[J]. 中华围产医学杂志, 2019,22(6):429-431.
	Zhao P, Lin L, Luan JY, et al. Risk factor assessment and management strategies for venous thromboembolism during pregnancy and puerperium[J]. Chin J Perinat Med, 2019,22(6):429-431.
[3]	Mitic G, Kovac M, Jurisic D, et al. Clinical characteristics and type of thrombophilia in women with pregnancy-related venous thromboembolic disease[J]. Gynecol Obstet Invest, 2011,72(2):103-108. doi: 10.1159/000323828
[4]	Barillari G, Londero AP, Brenner B, et al. Recurrence of venous thromboembolism in patients with recent gestational deep vein thrombosis or pulmonary embolism:findings from the RIETE registry[J]. Eur J Intern Med, 2016,32:53-59. doi: 10.1016/j.ejim.2016.02.013
[5]	王燕, 徐红兵. 孕产妇静脉血栓栓塞症的诊治[J]. 现代医药卫生, 2016,32(9):1352-1355.
	Wang Y, Xu HB. Diagnosis and treatment of venous thromboembolism in pregnant women[J]. J Mod Med Heal, 2016,32(9):1352-1355.
[6]	Chen Y, Dai Y, Song J, et al. Establishment of a risk assessment tool for pregnancy-associated venous thromboembolism and its clinical application:protocol for a prospective observational study in Beijing[J]. BMC Pregnancy Childbirth, 2019,19(1):1-8. doi: 10.1186/s12884-018-2145-y
[7]	袁晓兰, 李丽美, 和秀魁, 等. 全面放开“二孩”政策前后广东省妇幼保健院住院孕产妇分娩情况分析[J]. 中国妇幼保健, 2018,33(2):241-243.
	Yuan XL, Li LM, He XK, et al. Analysis on hospital delivery situation before and after implementation of comprehensive two-child policy in Guangdong Provincial Maternal and Child Health Care Hospital[J]. Matern Child Heal Care China, 2018,33(2):241-243.
[8]	胡岳敏, 程芙蓉, 陈裕坤. 二胎高龄生育的风险因素与孕前评估[J]. 中国医药科学, 2017,7(20):247-250.
	Hu YM, Cheng FR, Chen YK. Risk factors for advanced pregnancy with second child and pre pregnancy evaluation[J]. China Med Pharm, 2017,7(20):247-250.
[9]	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.
	Xie LM, Wang WY. A brief introduction to Appraisal of Gui-delines for Research and Evaluation Ⅱ[J]. J Chin Integr Med, 2012,10(2):160-165.
[10]	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.
	Zhu LQ, Zhuang R, Cao SM, et al. Evidence summary for risk assessment of PICC-related thrombosis[J]. Chin J Nurs, 2017,52(10):1179-1185.
[11]	顾莺, 张慧文, 周英凤, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具:系统评价的方法学质量评价[J]. 护士进修杂志, 2018,33(8):701-703.
	Gu Y, Zhang HW, Zhou YF, et al. JBI evidence-based health center’s quality assessment tool for different types of research—the quality evaluation of diagnostic and economic evaluation[J]. J Nurses Train, 2018,33(8):701-703.
[12]	朱政, 胡雁, 周英凤, 等. 推动证据向临床转化(五):证据临床转化研究中的文献质量评价[J]. 护士进修杂志, 2020,35(11):996-1000.
	Zhu Z, Hu Y, Zhou YF, et al. Promotion evidence to clinical transformation:evidence resource retrieval for the purpose of clinical transformation[J]. J Nurses Train, 2020,35(11):996-1000.
[13]	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
[14]	Bates SM, Rajasekhar A, Middeldorp S, et al. American Society of Hematology 2018 guidelines for management of venous thromboem bolism:venous thromboembolism in the context of pregnancy[J]. Blood Adv, 2018,2(22):3317-3359. doi: 10.1182/bloodadvances.2018024802
[15]	Royal College of Obstetricians and Gynaecologists. Thrombo-sis and embolism during pregnancy and the puerperium,redu-cing the risk（Green-top Guideline No. 37a）[EB/OL]. 2015-04-13). https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37a.pdf.
[16]	Royal College of Obstetricians and Gynaecologists. Thrombosis and Embolism during Pregnancy and the Puerperium：Acute Management（Green-top Guideline No. 37b）[EB/OL]. (2015-04-13). https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37b.pdf.
[17]	National Institute for Health and Care Excellence. Venous thromboembolism in over 16s：reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism[EB/OL]. (2018-08-13). https://www.nice.org.uk/guidance/ng89.
[18]	The American College of Obstetricians and Gynecologists. ACOG practice bulletin No. 196:thromboembolism in pregnancy[J]. Obstet Gynecol, 2018,132(1):e1-e17. doi: 10.1097/AOG.0000000000002706
[19]	中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第三版)[J]. 中国血管外科杂志(电子版), 2017,9(4):250-257.
	Vascular Surgery Group,Chinese Medical Association Surgery Branch. Guidelines for the diagnosis and treatment of deep vein thrombosis(third edition)[J]. Chin J Vasc Surg(Electronic Version), 2017,9(4):250-257.
[20]	Hassouna A, Allam H. Limited dose warfarin throughout preg-nancy in patients with mechanical heart valve prosjournal:a meta-analysis[J]. Interact Cardio Vasc Thorac Surg, 2014,18(6):797-806. doi: 10.1093/icvts/ivu009
[21]	Costi L, Lockwood C, Munn Z, et al. Women’s experience of diabetes and diabetes management in pregnancy:a systematic review of qualitative literature[J]. JBI Database of Systematic Reviews and Implementation Reports, 2014,12(1):176-280. doi: 10.11124/jbisrir-2014-1304
[22]	中国健康促进基金会血栓与血管专项基金专家委员会. 静脉血栓栓塞症机械预防中国专家共识[J]. 中华医学杂志, 2020,100(7):484-492.
	Expert Committee of China Health Promotion Foundation Thrombus and Vascular Special Fund. Chinese expert consensus on mechanical prevention of venous thromboembolism[J]. Natl Med J China, 2020,100(7):484-492.
[23]	Linnemann B, Scholz U, Rott H, et al. Treatment of pregnancy-associated venous thromboembolism - position paper from the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis(GTH)[J]. VASA.:Zeitschrift für Gefä-sskrankheiten. Journal for vascular diseases. 2016,45(2):103-118.
[24]	McLintock C, Brighton T, Chunilal S, et al. Recommendations for the prevention of pregnancy-associated venous thromboembolism[J]. Aust NZJ Obstet Gynaecol, 2012,52(1):3-13. doi: 10.1111/j.1479-828X.2011.01357.x
[25]	Whitehorn A. Venous thromboembolism：prevention and prophylaxis in medically ill hospitalized patients[EB/OL]. (2019-08-01). http://ovidsp.dc2.ovid.com/ovid-a/ovidweb.cgi
[26]	Costi L, Munn Z. Women’s experience of diabetes and diabetes management in pregnancy[J]. The Joanna Briggs Institute Database of Best Practice Information Sheets and Technical Reports, 2014,18(7):1-5.
[27]	Bain E, Wilson A, Tooher R, et al. Prophylaxis for venous throm-boembolic disease in pregnancy and the early postnatal period[J]. Cochrane Database Syst Rev, 2014. DOI: 10.1002/1465-1858.cd001689.pub2.