422例前置胎盘剖宫产产后出血危险因素的Logistic回归分析  

Logistic regression analysis of risk factors of postpartum hemorrhage in 422 cases of placenta previa cesarean section

作　　者：全丽虹 杨振华 傅彬 那娜 钟萍 QUAN Lihong;YANG Zhenhua;FU Bin;NA Na;ZHONG Ping(Obstetrics Department,the Second Affiliated Hospital of Guilin Medical University,Guilin 541199;Obstetrics Department,Guilin Maternal and Child Health Hospital,Guilin 541001;Ultrasound Department,the Second Affiliated Hospital of Guilin Medical University,Guilin 541199,China)

机构地区：[1]桂林医学院第二附属医院产科,广西桂林541199 [2]桂林市妇幼保健院产科,广西桂林541001 [3]桂林医学院第二附属医院超声科,广西桂林541199

出　　处：《临床医学研究与实践》2023年第11期1-4,共4页Clinical Research and Practice

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(No.Z-C20221001);广西壮族自治区医疗卫生重点学科建设项目(桂卫科教发〔2022〕4号)。

摘　　要：目的探讨前置胎盘剖宫产产后出血的危险因素。方法收集2016年1月至2022年9月桂林医学院第二附属医院和桂林市妇幼保健院两家产科中心收治的422例前置胎盘行剖宫产终止妊娠患者的临床资料,根据产后出血量不同将其分为研究组(68例,产后出血量≥1000 mL)和对照组(354例,产后出血量<1000 mL)。利用多因素Logistic回归分析筛选出独立危险因素,绘制受试者工作特性(ROC)曲线评估其预测效能。结果单因素分析结果显示,两组的年龄、孕次、产次、剖宫产史、前置胎盘类型、胎盘后低回声和胎盘腔隙比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,剖宫产史≥1次和胎盘后低回声消失是前置胎盘剖宫产患者产后出血的独立危险因素(P<0.05)。胎盘后低回声、剖宫产史预测前置胎盘剖宫产患者产后出血的ROC曲线下面积(AUC)分别为0.577、0.640,两者联合的AUC为0.719。结论剖宫产史≥1次及胎盘后低回声消失是前置胎盘剖宫产产后出血的独立危险因素,两者联合具有较好的预测价值。Objective To explore the risk factors of postpartum hemorrhage in placenta previa cesarean section.Methods The clinical data of 422 patients with placenta previa who underwent cesarean section for termination of pregnancy from January 2016 to September 2022 in obstetrics center of the Second Affiliated Hospital of Guilin Medical University and Guilin Maternal and Child Health Hospital were collected.According to the amount of postpartum hemorrhage,the patients were divided into study group(68 cases,postpartum hemorrhage≥1000 mL)and control group(354 cases,postpartum hemorrhage<1000 mL).Multivariate Logistic regression analysis was used to screen out independent risk factors,and the receiver operating characteristic(ROC)curve was drawn to evaluate their predictive efficacy.Results Univariate analysis results showed that there were statistically significant differences in age,gravidity,parity,history of cesarean section,type of placenta previa,low echo behind placenta and placental lacuna between the two groups(P<0.05).The multivariate Logistic regression analysis showed that history of cesarean section≥1 time and disappearance of low echo behind placenta were independent risk factors for postpartum hemorrhage in patients with placenta previa after cesarean section(P<0.05).The area under curve(AUC)of ROC of low echo behind placenta and history of cesarean section in predicting postpartum hemorrhage in patients with placenta previa cesarean section were 0.577 and 0.640,respectively;the AUC of combination of the two was 0.719.Conclusion The history of cesarean section≥1 time and disappearance of low echo behind placenta are independent risk factors for postpartum hemorrhage after cesarean section of placenta previa,the combination of the two has good predictive value.

关 键 词：前置胎盘 剖宫产 产后出血 危险因素 

分 类 号：R719.8[医药卫生—妇产科学]