产后胚物残留合并子宫动静脉瘘发病的危险因素分析  

Analysis of risk factors of fetal residue after delivery combined with uterine arteriovenous fistula

作　　者：杨小杰[1] 陈昀 何桦 李梦雪 杨利华 黄俊敏 张雪松[1] 汪莹[1] Yang Xiaojie;Chen Yun;He Hua;Li Mengxue;Yang Lihua;Huang Junmin;Zhang Xuesong;Wang Ying(Department of Obstetrics and Gynecology,Maternal and Child Health Care Hospital of Tangshan,Hebei Province,Tangshan 063000,China;Department of Ultrasound,Yutian Hospital of Traditional Chinese Medicine of Tangshan,Hebei Province,Tangshan 063000,China)

机构地区：[1]河北省唐山市妇幼保健院妇产科,063000 [2]河北省唐山市玉田县中医院超声科,063000

出　　处：《中国综合临床》2021年第4期339-343,共5页Clinical Medicine of China

基　　金：河北省医学科学研究课题计划(20191526)。

摘　　要：目的探讨产后胚物残留合并子宫动静脉瘘发生的危险因素。方法选取河北省唐山市妇幼保健院2000年1月至2020年12月近20年内产后胚物残留合并子宫动静脉瘘患者26例作为病例组;选取同时段产后胚物残留未并发子宫动静脉瘘患者32例作为对照组,病例组及对照组均为剖宫产瘢痕部位胚物残留。通过单因素及多因素Logistic分析,筛选产后胚物残留合并子宫动静脉瘘发病的危险因素。结果病例组患者共26例,其中药物流产术后患者3例,人工流产术后患者17例,剖宫产术后患者2例,中期引产产后患者4例。对照组患者32例,其中药物流产术后患者7例,人工流产术后患者11例,剖宫产术后患者8例,中期引产产后患者6例。病例组中因大出血就诊患者11例,对照组中因大出血就诊患者3例。单因素分析结果显示:产后胚物残留合并子宫动静脉瘘的发生与阴道出血时间(t=3.481)、治疗前后血绒毛膜促性腺激素(human chorionic gonadotropin,HCG)值(t值分别为5.206、3.707)、治疗前血红蛋白值(t=6.245)、血小板计数(t=0.910)、残留胚物面积有关(t=2.137)(P均<0.05)。多因素回归分析显示:治疗前血HCG升高(OR 20.319,95%CI 1.348~306.187)、治疗前血红蛋白值降低(OR 0.870,95%CI 0.788~0.960)是产后胚物残留合并子宫动静脉瘘的独立危险因素(P<0.05)。结论治疗前血HCG值升高、血红蛋白值降低的产后胚物残留患者,存在并发子宫动静脉瘘的风险因素,应高度警惕,尽量减少临床漏诊率。Objective To investigate the risk factors of postpartum embryo residues associated with uterine arteriovenous fistula.Methods From January 2000 to December 2020,26 cases of postpartum embryo residue complicated with uterine arteriovenous fistula in Tangshan Maternal and Child Health Hospital were selected as the case group,and 32 cases of postpartum embryo residue without uterine arteriovenous fistula were selected as control group.Both the case group and the control group had embryo residue in cesarean scar.Univariate and multivariate logistic analysis were used to screen the risk factors of postpartum embryo residue combined with uterine arteriovenous fistula.Results There were 26 patients in the case group,including 3 patients after medical abortion,17 patients after artificial abortion,2 patients after cesarean section,and 4 patients after mid-term induced labor.There were 32 patients in the control group,including 7 patients after medical abortion,11 patients after induced abortion,8 patients after cesarean section,and 6 patients after mid-term induced labor.There were 11 patients in the case group and 3 patients in the control group.Univariate analysis showed that:the occurrence of postpartum embryo residue combined with uterine arteriovenous fistula was related to the time of vaginal bleeding,HCG value before and after treatment,hemoglobin value before treatment,platelet count and residual embryo area(all P<0.05).Multivariate regression analysis showed that the increase of hCG before treatment(OR 20.319,95%CI 1.348-306.187)and the decrease of hemoglobin before treatment(OR 0.870,95%CI 0.788-0.960)were the independent risk factors of postpartum embryo residue combined with uterine arteriovenous fistula(all P<0.05).Conclusion The risk factors of uterine arteriovenous fistula in postpartum embryo residue patients with elevated hCG value and decreased hemoglobin value before treatment should be highly vigilant to reduce the rate of clinical missed diagnosis.

关 键 词：胚物残留 子宫动静脉瘘 危险因素 

分 类 号：R714.6[医药卫生—妇产科学]