产后出血的危险因素及血清AT-Ⅲ、BNP、NO对其预测价值探讨  

Risk factors of postpartum hemorrhage and the predictive value of serum AT-Ⅲ,BNP and NO

作　　者：何佳佳 漆洪波[2] 邓娜 杨燕 罗将来 陈进琼 HE Jiajia;QI Hongbo;DENG Na;YANG Yan;LUO Jianglai;CHEN Jinqiong(Obstetrics Department,Chongqing Dianjiang County People′s Hospital,Chongqing 408300,China;Obstetrics Department,the First Affiliated Hospital of Chongqing Medical University,Chongqing 408300,China)

机构地区：[1]重庆市垫江县人民医院产科,重庆408300 [2]重庆医科大学附属第一医院产科,重庆400000

出　　处：《中国性科学》2020年第3期85-89,共5页Chinese Journal of Human Sexuality

基　　金：重庆市卫生计生委医学科研项目(2017ZBXM056)。

摘　　要：目的分析产后出血的危险因素及血清抗凝血酶-Ⅲ(AT-Ⅲ)、脑尿利肽(BNP)、一氧化氮(NO)对其预测价值。方法选取2016年1月至2018年12月重庆市垫江县人民医院产科住院分娩的359例孕产妇作为研究对象。359例孕产妇根据分娩后出血情况将53例产后出血者作为研究组,余下306例无产后出血者作为对照组,分析产后出血的危险因素,及血清AT-Ⅲ、BNP、NO对其预测价值。结果对照组和研究组年龄、BMI、流产次数、产次、分娩孕周、分娩方式、胎儿体质量、妊娠并发症、胎盘粘连及前置胎盘率、血清AT-Ⅲ、BNP、NO水平比较有统计学差异(P<0.05)。多因素Logistic回归分析显示,流产次数、分娩方式、胎儿体质量、妊娠并发症、胎盘粘连、前置胎盘、血清BNP、NO水平是产后出血的危险因素,AT-Ⅲ为其发生的保护因素。血清AT-Ⅲ预测产后出血ROC曲线下面积为0.757,敏感性为0.906,特异性为0.516;BNPROC曲线下面积为0.835,敏感性为0.717,特异性为0.836;NO曲线下面积为0.779,敏感性为0.736,特异性为0.725;AT-Ⅲ+BNP+NOROC曲线下面积为0.925,敏感性为0.887,特异性为0.826。结论产后出血的发生和多种危险因素相关,其中产前监测AT-Ⅲ、BNP及NO对其有一定预测价值,临床应对有出血倾向的产妇进行积极的医学干预。Objective To analyze the risk factors of postpartum hemorrhage and the predictive value of serum antithrombin-Ⅲ(AT-Ⅲ),the brain-urine natriuretic peptide(BNP),nitric oxide(NO).Methods According to the postpartum hemorrhage situation,53 cases with postpartum hemorrhage were selected as the research group,and the remaining 306 cases were selected as the control group.Risk factors of postpartum hemorrhage and the predictive value of serum AT-Ⅲ,BNP,NO were analyzed.Results Differences in the age,BMI,number of abortions,parity,gestational age,delivery mode,fetal body quality,pregnancy complications,the rate of placenta adhesion and placenta previa and the serum level of AT-Ⅲ,BNP,NO between the control group and research group were statistically significant(P<0.05).Multiariable Logistic regression analysis showed that miscarriage number,delivery mode,fetal body quality,pregnancy complications,placenta conglutination,placenta previa and serum BNP and NO levels were all risk factor for postpartum hemorrhage,while AT-Ⅲwas a protective factor.The postpartum hemorrhage area under the ROC curve predicted by serum AT-Ⅲwas 0.757,the sensitivity and specificity being 0.906 and 0.516;The area under BNPROC curve was 0.835,the sensitivity and specificity being 0.717 and 0.836;The area under NO curve was 0.779,the sensitivity and specificity being 0.736 and 0.725;The AT-Ⅲ+BNP+NO ROC area under the curve was 0.925,the sensitivity and specificity being 0.887 and 0.826.Conclusions Postpartum hemorrhage is associated with a variety of risk factors,among which prenatal monitoring of AT-Ⅲ,BNP and NO has certain predictive value.Active medical intervention should be carried out among pregnant women with hemorrhage tendency.

关 键 词：产后出血 危险因素 抗凝血酶-Ⅲ 脑尿钠肽 一氧化氮 

分 类 号：R714[医药卫生—妇产科学]