产后出血相关危险因素分析与治疗方法比较  

Analysis for the related risk factors of postpartum hemorrhage and intervention methods

作　　者：刘会芹 赵润果 王芳 于雪梅 闫翠芳 张建兰 李莎[4] LIU Huiqin;ZHAO Runguo;WANG Fang(Department of Gynaecology and Obstetrics,Ci County Hospital for Maternal and Child Health,Hebei,Ci County 056500,China)

机构地区：[1]河北省磁县妇幼保健院妇产科,056500 [2]河北省邯郸市中心医院妇产科 [3]河北省磁县磁州医院妇产科 [4]天津医科大学附属天津中心妇产医院妇产科

出　　处：《河北医药》2018年第5期748-751,共4页Hebei Medical Journal

基　　金：邯郸市科学技术研究与发展计划项目(编号:1623208065-5)

摘　　要：目的探讨产后出血的相关危险因素与各种止血干预措施。方法回顾性统计4家医院总分娩孕产妇,以发生产后出血患者为病例组,按照1∶2病例随机选择同期未发生产后出血孕产妇178例为对照组,分析2组患者影响产后出血的各种因素,采用Logistic回归分析筛查影响产后出血相关危险因素。统计不同方式分娩者因产后出血而需要输血比例,分析产后出血分娩者临床止血干预措施。结果总分娩孕产妇1 391例,产后出血者89例,产后出血发生率89/1 391(6.40%)。单因素分析显示,产后出血组与对照组比较,分娩方式、胎盘黏连(植入)、前置胎盘、宫缩乏力、产道裂伤、剖宫产次数、流产次数、分娩孕周、妊娠合并症是影响产后出血的主要原因。多因素回归分析宫缩乏力、前置胎盘、胎盘黏连、分娩方式、剖宫产次数、流产次数是产后出血的危险因素。其中自然分娩者因产后出血发生输血患者20例,剖宫产者因产后出血后输血69例(一次剖宫产26例,二次剖宫产33例,三次剖宫产10例),剖宫产者因产后出血后输血发生率比自然分娩者显著增加,差异有统计学意义(χ~2=31.094,P<0.05)。剖宫产者产后输血率随剖宫产次数增加而上升,三者比较差异有统计学意义(χ~2=22.13,P<0.05)。89例产后出血患者中,34例通过常规药物治疗而好转,19例通过子宫腔内填塞纱条止血,手术治疗患者36例(其中盆腔血管结扎止血12例,改良B-Lynch缝合术13例,Bakri止血球囊止血7例,子宫切除术4例)。结论产后出血发生受到多种因素影响,宫缩乏力、前置胎盘、胎盘黏连、分娩方式、剖宫产次数、流产次数是产后出血的危险因素;剖宫产病例产后出血发生率高于自然分娩者,剖宫产次数越多,产后出血发生率越高,提倡自然分娩降低剖宫产率是减少产后出血节约血资源,保障母婴安全有效措施;多种干预措施对产后出血患者均有Objective To investigate the related risk factors of postpartum hemorrhage,and to explore various hemostatic intervention measures.Methods The parturients with postpartum hemorrhage who were admitted and treated in four hospitals from January 2016 to June 2016 were enroled as case group,at the same time,the 178 parturients without postpartum hemorrhage were enrolled as control group.The various factors influencing postpartum hemorrhage were analyzed and compared between two groups.Moreover the related risk factors with postpartum hemorrhage were analyzed by means of Logistic regression analysis.Moreover the proportion of blood transfusion because of postpartum hemorrhage in different delivery ways was statisticall analyzed,and the clinical hemostatic intervention measures were analyzed and compared between two groups.Results Among 1,391 puerpera,89 cases had postpartum hemorrhage,with the incidence rate of postpartum hemorrhage being 6.40%(89/1,391).The univariate analysis showed that delivery mode,placental adhesion(implant),placenta previa,uterine atony,laceration of birth canal,the frequency of cesarean section,frequency of abortion,gestational weeks,pregnancy complications were the risk factors of postpartum hemorrhage.The multivariate regression analysis showed that uterine atony,placenta previa,placental adhesion,delivery mode,frequency of caesarean section and abortion were the risk factors of postpartum hemorrhage.In addition 26 puerpera with natural childbirth received blood transfusion because of postpartum hemorrhage,and 69 puerpera with cesarean section received blood transfusion because of postpartum hemorrhage,the incidence of blood transfusion because of postpartum hemorrhage in puerpera with cesarean section was significantly increased,as compared with that of puerpera with natural childbirth(P<0.05),moreover the incidence of blood transfusion because of postpartum hemorrhage in puerpera with cesarean section was significantly increased with the increase of frequency of cesarean section(P<0.05).In

关 键 词：自然分娩 剖宫产 产后出血 

分 类 号：R722.6[医药卫生—儿科]