三“十”措施在产后出血防治的临床应用研究  

Clinical application of three "ten" measures in postpartum hemorrhage prevention and treatment

作　　者：雷晓真 辛思明[1] 周小飞[1] 江萍 何明生 蓝莹 付兰兰[5] 郑九生[1] 

机构地区：[1]江西省妇幼保健院产科,南昌330006 [2]江西省上栗县妇幼保健院妇产科,上栗337000 [3]江西省修水县妇幼保健院妇产科,修水332400 [4]江西省于都县妇幼保健院妇产科,于都342300 [5]江西省石城县人民医院妇产科,石城342700

出　　处：《江西医药》2017年第8期729-732,共4页Jiangxi Medical Journal

基　　金：江西省卫生厅课题;编号20151132

摘　　要：目的 探讨产后出血防治三"十"措施临床研究的意义及价值。方法 采用多中心、大样本、前瞻性临床病例对照研究方法 ,在省县共建的5家医院(1家三甲医院和4家二甲医院)集中培训,2015年1月至2016年12月统一进行产后出血防治的三"十"措施的实施方案,2年内发生产后出血病例为研究组,实施前的2013年1月至2014年12月5家医院发生的产后出血病例为对照组,对实施三"十"措施前后二年的产后出血发生率、严重产后出血发生率、子宫切除率、多器官功能障碍综合征(MODS)发生率、产妇死亡率进行比较。结果 江西省妇幼保健院(三甲)研究组和对照组两年内发生产后出血率为5.87%和7.11%,严重产后出血发生率0.79%和1.11%,差异有显著统计学意义(P<0.01);其余4家二甲医院(上栗县妇幼保健院、修水县妇幼保健院、于都县妇幼保健院、石城县人民医院)研究组和对照组两年内发生产后出血率为0.98%和1.41%;1.53%和2.61%;1.87%和2.64%;0.98%和1.52%,差异有统计学意义(P<0.05)。结论 三"十"措施可降低产后出血发生率、严重产后出血发生率;但在三甲医院,由于二甲医院转诊危重症病人多,近年来剖宫产史伴胎盘植入孕妇增多,子宫切除率无明显降低,因此应降低剖宫产率,倡导阴道分娩。Objective To explore the significance and value of clinical research on the Three ＂ten measures＂ prevention and treatment of postpartum hemorrhage. Methods Apply the method of clinical case controlled study with multi-center,large-sample and prospective. Organize concentrated training in five province-county co-built general hospitals（one 3A grade hospital and four2 A grade hospitals）. The study initiated the three ＂ten＂ measures program on prevention and control of postpartum hemorrhage from January 2015 to December 2016. Postpartum hemorrhage cases happened in the five hospitals within the two years are set as research group,while cases happened from January 2013 to December 2014 in the five hospitals are set as controlled group,in an effort to compare the Incidence of postpartum hemorrhage,severe postpartum hemorrhage,hysterectomy rate,multiple organ dysfunction syndrome（MODS） incidence,maternal mortality between the two group. Results The postpartum hemorrhage rate in Jiangxi Maternal and child health hospital（3A grade hospital） was 5.87% and 7.11% for study group and control group respectively within two years,and the incidence of severe postpartum hemorrhage was 0.79% and 1.11%,respectively（P〈0.01）,The difference was remarkable statistically significant. The postpartum hemorrhage rates in the other four 2A grade hospitals（Shangli County Maternal and child health hospital;Xiushui County Maternal and child health hospital;Yudu County Maternal and child health hospital and Shicheng County People＇s hospital） were 0.98% and 1.41%;1.53% and 2.61%;1.87% and 2.64%;0.98% and1.52%,respectively,and the difference was statistically significant（P〈0.05）. Conclusion The three ＂ten＂ measures can reduce the incidence of postpartum hemorrhage and the incidence of severe postpartum hemorrhage. However,in the 3A grade hospitals,as the number of patients in critical conditions transferred from 2A grade hospital is significantly high,and the pregnant cesarean section with placenta accret

关 键 词：产后出血 防治 三“十”措施 

分 类 号：R714.461[医药卫生—妇产科学]