严重产后出血患者紧急子宫切除的危险因素分析及风险预测  

Risk factors analysis and risk prediction of emergency hysterectomy in patients with severe postpartum hemorrhage

作　　者：王一枭 李婷[1] 高娅[2] 丁虹娟[1] WANG Yixiao;LI Ting;GAO Ya;DING Hongjuan(Department of Obstetrics,Women′s Hospital of Nanjing Medical University/Nanjing Maternity and Child Health Care Hospital,Nanjing,Jiangsu 210004,China;Department of Information,Women′s Hospital of Nanjing Medical University/Nanjing Maternity and Child Health Care Hospital,Nanjing,Jiangsu 210004,China)

机构地区：[1]南京医科大学附属妇产医院/南京市妇幼保健院产科,南京210004 [2]南京医科大学附属妇产医院/南京市妇幼保健院信息科,南京210004

出　　处：《重庆医学》2022年第4期579-583,共5页Chongqing medicine

基　　金：国家自然科学基金项目(81771604)。

摘　　要：目的探讨严重产后出血(PPH)患者紧急子宫切除的危险因素,并分析其预测价值。方法回顾性分析该院2017年1月至2020年6月发生严重PPH(产后24 h内出血总量超过2000 mL)的223例产妇资料,其中38例产妇行紧急子宫切除纳入观察组,其余185例产妇纳入对照组。采用单因素分析及logistic回归分析确定紧急子宫切除的影响因素,并绘制受试者工作特征(ROC)曲线,分析其预测紧急子宫切除的效能。结果单因素分析结果显示,凶险性前置胎盘、胎盘植入、既往妊娠1~2次、既往妊娠次数≥3次、既往剖宫产次数≥2次、早产、羊水栓塞、弥散性血管内凝血8个临床指标与紧急子宫切除相关(P<0.05)。logistic回归分析显示,胎盘植入[aOR=3.249,95%CI(1.186,8.903),P=0.02]和弥散性血管内凝血[aOR=4.101,95%CI(1.046,16.074),P=0.04]是严重PPH产妇紧急子宫切除的危险因素。两种危险因素联合的ROC曲线下面积为0.680[95%CI(0.586,0.774),P<0.001],预测灵敏度为73.70%,特异度为58.90%,约登指数为0.33。结论胎盘植入和弥散性血管内凝血联合对严重PPH产妇紧急子宫切除有一定的预测价值。Objective To investigate the risk factors of emergency hysterectomy in patients with severe postpartum hemorrhage(PPH),and analyze their predictive value.Methods The data of 223 patients with severe PPH(the total amount of hemorrhage exceeded 2000 mL within 24 hours after delivery)in the Women′s Hospital of Nanjing Medical University from January 2017 to June 2020 were retrospectively analyzed,of which 38 cases received emergency hysterectomy were included in the observation group,and the remaining 185 cases were included in the control group.The univariate analysis and logistic regression analysis were used to determine the influencing factors of emergency hysterectomy,and the receiver operating characteristic(ROC)curve was drawn to analyse their effectiveness in predicting emergency hysterectomy.Results The results of the univariate analysis showed that eight clinical indicators were significantly correlated with emergency hysterectomy,including dangerous placenta previa,placenta implantation,1-2 previous pregnancies,≥3 previous pregnancies,≥2 previous cesarean sections,premature delivery,amniotic fluid embolism and disseminated intravascular coagulation(P<0.05).The results of the logistic regression analysis showed that placental implantation[aOR=3.249,95%CI(1.186,8.903),P=0.02]and disseminated intravascular coagulation[aOR=4.101,95%CI(1.046,16.074),P=0.04]were risk factors for emergency hysterectomy in patients with severe PPH.The area under the ROC curve for emergency hysterectomy was 0.680[95%CI(0.586,0.774),P<0.001]for the combination of the two risk factors,the predictive sensitivity was 73.70%,the specificity was 58.90%,and the Youden index was 0.33.Conclusion The combination of placenta implantation and disseminated intravascular coagulation has a certain predictive value for emergency hysterectomy of patients with severe PPH.

关 键 词：严重产后出血 子宫切除 危险因素 风险预测 

分 类 号：R714.461[医药卫生—妇产科学]