重庆地区重复剖宫产术中出血危险因素分析  

Analysis of risk factors of bleeding during repeated cesarean section in Chongqing

作　　者：黄立[1] 杨沁岩 张世焱 陈竹 周子淞 罗玲 张吉培 刘超 李应清[7] 纪成城 姚志敏 HUANG Li;YANG Qinyan;ZHANG Shiyan;CHEN Zhu;ZHOU Zisong;LUO Ling;ZHANG Jipei;LIU Chao;LI Yingqing;JI Chengcheng;YAO Zhimin(Department of Anesthesiology,Chongqing Seventh People's Hospital,Chongqing 400054,China;Department of Anesthesiology,Chongqing Wansheng Economic Development Zone People's Hospital,Chongqing 400800,China;Department of Anesthesiology,Chongqing Dadukou District People's Hospital,Chongqing 400000,China;Department of Anesthesiology,Chongqing Nanchuan District People's Hospital,Chongqing 408400,China;Department of Anesthesiology,Chongqing Nanchuan District Hongren Hospital,Chongqing 408400,China;Department of Anesthesiology,Chongqing Pengshui People's Hospital,Chongqing 409600,China;Department of Anesthesiology,Chongqing Qijiang District People's Hospital,Chongqing 401420,China;Department of Anesthesiology,Chongqing Jiangbei District Hospital of Traditional Chinese Medicine,Chongqing 400020,China;Department of Anesthesiology,the Army 958th Hospital,Chongqing 400000,China)

机构地区：[1]重庆市第七人民医院麻醉科,重庆400054 [2]重庆市万盛经开区人民医院麻醉科,重庆400800 [3]重庆市大渡口区人民医院麻醉科,重庆400000 [4]重庆市南川区人民医院麻醉科,重庆408400 [5]重庆市南川区宏仁医院麻醉科,重庆408400 [6]重庆市彭水县人民医院麻醉科,重庆409600 [7]重庆市綦江区人民医院麻醉科,重庆401420 [8]重庆市江北区中医院麻醉科,重庆400020 [9]陆军第九五八医院麻醉科,重庆400000

出　　处：《现代医药卫生》2022年第16期2748-2752,共5页Journal of Modern Medicine & Health

基　　金：重庆市科卫联合医学科研项目(2019QNXM009);重庆市巴南区社会事业与民生保障科技创新专项项目(2021-54)。

摘　　要：目的探讨重复剖宫产术中出血的危险因素。方法收集2014年1月至2019年12月重庆市19家医院13582例行重复剖宫产手术分娩产妇的病例资料,根据术中出血量情况将其分为出血组(2216例)和未出血组(11366例)。比较2组相关临床指标,分析重复剖宫产术中出血的影响因素,并绘制受试者工作特征(ROC)曲线,计算曲线下面积。结果2组在年龄、流产史、剖宫产次数、妊娠合并糖尿病、孕周、前置胎盘、植入胎盘、子宫收缩乏力、麻醉方式、巨大儿方面比较,差异有统计学意义(P<0.05)。年龄、术前血红蛋白、术前血钙、流产史、剖宫产次数(>2次)、妊娠合并糖尿病、前置胎盘、全身麻醉、巨大儿、子宫收缩乏力是重复剖宫产术中出血的影响因素(P<0.05)。ROC曲线下面积为0.717(95%CI:0.703~0.732)时,回归模型具有很好的预测价值。结论对于重复剖宫产产妇,年龄、术前血红蛋白、术前血钙、流产史、剖宫产次数(>2次)、妊娠合并糖尿病、前置胎盘、全身麻醉、巨大儿、子宫收缩乏力是术中出血的影响因素。临床应及时监测和调整可控的风险因素,以降低术中出血发生率和不良妊娠结局。Objective To explore the risk factors of bleeding during repeated cesarean section.Methods The data of 13582 cases of repeated cesarean section in 19 hospitals in Chongqing from January 2014 to December 2019 were collected.According to the amount of intraoperative bleeding,the patients were divided into the bleeding group(2216 cases)and the non-bleeding group(11366 cases).The related clinical in-dexes of the two groups were compared,the influencing factors of bleeding during repeated cesarean section were analyzed,the receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was calculated.Results There were significant differences between the two groups in terms of age,abortion history,frequency of cesarean section,pregnancy with diabetes,gestational weeks,placenta previa,placenta accreta,uterine atony,anesthesia method and macrosomia(P<0.05).Age,preoperative hemoglobin,preoperative blood calcium,abortion history,number of cesarean sections(>2 times),pregnancy with diabe-tes,placenta previa,general anesthesia,macrosomia,and uterine atony were the influencing factors of bleeding during repeated cesarean section(P<0.05).When AUC was 0.717(95%CI:0.703~0.732),the regression model had good predictive value.Conclusion For repeated cesarean section,age,preoperative hemoglobin,pre-operative blood calcium,abortion history,number of cesarean sections(>2 times),pregnancy with diabetes,placenta previa,general anesthesia,macrosomia,and uterine atony are the influencing factors of intraoperative bleeding.The controllable risk factors should be monitored and adjusted in time to reduce the incidence of in-traoperative bleeding and adverse pregnancy outcomes.

关 键 词：危险因素 术中出血 重复剖宫产 产妇 重庆 

分 类 号：R714.15[医药卫生—妇产科学]