初探建立严重产后出血及严重并发症的预测评估系统  

Establishment of a severe postpartum hemorrhage and the severe complication prediction scoring system

作　　者：沈宇清[1,2] 陈敦金[1] 

机构地区：[1]广州医学院第三附属医院妇产科,510150 [2]广东省开平市中心医院妇产科

出　　处：《中华产科急救电子杂志》2013年第1期34-38,共5页Chinese Journal of Obstetric Emergency（Electronic Edition）

摘　　要：目的探讨建立严重产后出血预测评估系统，以指导临床处理。方法采用回顾性研究方法，对广州医学院第三附属医院2000年1月至2008年6月收治的375例严重产后出血患者资料进行评分，分析所得分值与各器官功能障碍、并发症及预后的关系，建立产后出血预测评估系统。数据分析采用x^2检验、Fisher确切概率法、线性趋势检验和logistic回归分析。结果严重产后出血风险预测公式logeY／（1-Y）=-7．274＋0．858×产前评分＋0．821×产后评分，初步得出指导临床处理的分值：评分为4分患者2器官功能障碍发生率显著增加（x^2=13．23，P〈0．01），评分12分患者3个以上器官功能障碍发生率明显升高（x^2=54．21，P〈0．01）。评分为8分组母亲子宫切除率显著升高（x^2=20．65，P〈0．01）；严重产后出血在评分6分组与1—5分组（x^2=10．85，P〈0．01）、8分组与6～7分组（x^2=4．68，P〈0．05）、12分组与8～11分组（x^2=10．53，P〈0．01），差异具有统计学意义。结论该评估系统可以有效预测严重产后出血的发生风险并评估产后出血患者的病情危重程度，进一步评价还需大样本量的研究。Objective To provide guideline for the clinical management of postpartum hemorrhage, and to build up a scoring system for the prediction of severe postartum hemorrhage. Methods This study reviewed 375 pregnant women with severe postpartum hemorrhage, who were treated on the Third Affiliated Hospital of Guangzhou Medical University from January 2000 to June 2008. Then we analyzed the relationship between scores and the maternal outcomes, which included organ dysfunction, hysterectomy and death, and established the prediction scoring system for postpartum hemorrhage. The data were analyzed using Z 2 test, Fisher exact probability test, linear association and logistic regression. Results log eY / （1 -Y） = -7. 274 ＋0. 858 x prenatal score ＋0. 821 x postpartum score was the formula of prediction for sever postapartume hemorrhage. The score was 4 which suggested the incresing risk of organ dysfunction （Z 2 = 13.23 ,P 〈0. 01 ）, and 12 scores suggested the incresing risk of three or more organs dysfunction （Z 2 = 54. 21, P 〈 0. 01 ）. Over 8 scores suggested the risk of hysterectomy was increased significantly（z 2 = 20. 65, P 〈 0. 01 ）. There were significantly difference of serve postpartum hemorrhage between score 6 group and score 1 - 5 group （Z 2 = 10. 85, P 〈 0. 01 ）. And sever postpartum hemorrhage also had significant difference between score 8 group and 6 - 7 group （Z 2 = 4. 68, P 〈 0. 05 ）, score 12 group and score 8 - 11 group（Z 2 = 10. 53, P 〈 0. 01 ）. Conclusions The prediction scoring system can be used to predict effectively the risk of severe postpartum hemorrhage and evaluate the serious degree of situation. In the further, we need a research on a large scale.

关 键 词：产后出血 预测 质量指标 卫生保健 妊娠结局 

分 类 号：R714.461[医药卫生—妇产科学]