严重产后出血致子宫切除原因及危险因素分析  

Study on cause and risky factor of hysterectomy due to severe postpartum hemorrhage

作　　者：杨艳华[1] 梁秀坤[2] 

机构地区：[1]天门市第一人民医院妇产科,湖北天门431700 [2]鞍山市中医院妇产科,辽宁鞍山114004

出　　处：《中国计划生育和妇产科》2015年第11期26-29,共4页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的 探讨严重产后出血（postpartum hemorrhage,PPH）致子宫切除的原因和危险因素。方法 将2004年10月至2014年10月在天门市第一人民医院妇产科因严重PPH行子宫切除术31例患者纳入观察组,同期62例PPH但未达到子宫切除指征产妇为对照组。分析两组产妇临床资料和难治性PPH致子宫切除的危险因素。结果 31例子宫切除原因为凝血功能障碍14例（45.2%）,胎盘因素11例（35.5%）,宫缩乏力5例（16.1%）,贫血与血小板减少1例（3.2%）,观察组中剖宫产与自然分娩原因构成有差异（P〈0.05）,观察组与对照组构成有差异（P〈0.05）。Logistic回归分析显示剖宫产（OR=1.883,95%CI：1.177~1.980）、多胎妊娠（OR=2.587,95%CI：1.718~4.882）、巨大儿（OR=1.438,95%CI：1.280~2.736）是独立影响因素。结论 严重PPH子宫切除常见病因为凝血功能障碍、胎盘因素和宫缩乏力;不同分娩方式出血原因构成不同;剖宫产、巨大儿和多胎妊娠是危险因素。Objective To study the cause and risk factors of hysterectomy due to severe postpartum hemorrhage （PPH）. Methods The 31 cases with hysterectomy due to severe PPH in Tianmen First People＇s Hospital from Oct 2004 to Oct 2014 were chosen as observation group, 62 cases with PPH who did not reach the hysterectomy indications in the same period were selected as control group. Clinical data and risk factors of hysterectomy due to severe PPH were analyzed. Results Reasons of hysterectomy of the 31 cases included： 14 cases （45.2 % ） were coagulation disorder, 11 cases （35.5 % ） were placental factor, 5 cases （16. 1% ） were uterine inertia, 1 case （3.2 % ） was anemia. There were significant differences in hemorrhage reasons between caesarean section and spontaneous labor in observation group（P 〈 0.05 ）, and there was a significant difference in hemorrhage reason between observation group and control group（P 〈0.05）. Logistic aggression revealed caesarean section（ OR = 1. 883,95 % CI：1. 177 - 1. 980）, multiple pregnancy（ OR = 2. 587,95 % CI ： 1. 718 - 4. 882 ）, macrosomia （ OR = 1. 438,95 % CI ： 1. 280 - 2. 736） were influence factors. Conclusion Coagulation disorders, placenta factor, uterine inertia were major causes of hysterectomy due to severe PPH. There were different bleeding causes between cesarean section and spontaneous labor. The multiple pregnancy, macrosomia and were multiple pregnancy the risk factors.

关 键 词：产后出血 子宫切除 危险因素 

分 类 号：R714.461[医药卫生—妇产科学]