前置胎盘患者严重产后出血相关危险因素分析  

Analysis of Risk Factors Related to Severe Postpartum Hemorrhage in Patients with Placenta Previa

作　　者：王敬唯 刘秀丽 刘芳 魏蕾郦 胡德凤 张天奇 宋朝军 王永锐 谢佳 张仔沂 Wang Jingwei;Liu Xiuli;Liu Fang(Panzhihua Maternal and Child Health Hospital,Panzhihua,Sichuan 617000,China)

机构地区：[1]攀枝花市妇幼保健院,四川攀枝花617000 [2]攀枝花市中心医院,四川攀枝花617000 [3]川北医学院,四川南充637007

出　　处：《四川医学》2024年第9期998-1002,共5页Sichuan Medical Journal

基　　金：攀枝花市科学技术局市级指导性科技计划项目(编号:2022ZD-S-40)。

摘　　要：目的探讨前置胎盘严重产后出血的危险因素,以期降低前置胎盘严重产后出血发生率。方法选取2018年1月至2022年9月在攀枝花市妇幼保健院及攀枝花市中心医院因“前置胎盘”分娩的符合纳入排除标准的孕妇作为研究对象,收集患者相关信息,依据产后24 h出血量,分为出血量<1000 ml组和≥1000 ml组。分析引起严重产后出血的危险因素,采用单因素分析确定有意义的危险因素,用多因素Logistic回归模型进行相关因素分析,建立前置胎盘患者严重产后出血的预测模型。结果共纳入研究对象364例,其中产后出血量≥1000 ml的有114例。36个变量进行单因素分析,结果显示年龄、孕次、产次、剖宫产次数、既往早产史、既往子宫手术史、本次妊娠胎盘附着部位、术中胎盘情况、本次终止妊娠方式、麻醉方式、术中止血缝合方式、促子宫收缩药物使用等12个变量的检验统计量具有统计学意义(P<0.05),提示它们为前置胎盘相关严重产后出血的危险因素。Logistic回归模型分析显示,胎盘粘连(OR=3.164,95%CI 1.704~5.873),胎盘植入(OR=6.138,95%CI 2.640~14.273),剖宫产次数(1次)(OR=2.426,95%CI 1.378~4.273),全麻(OR=4.103,95%CI 2.145~7.847),是严重产后出血的危险因素。结论既往剖宫产次数、胎盘粘连、胎盘植入、全麻是引起前置胎盘严重产后出血的危险因素,促子宫药物使用是引起前置胎盘严重产后出血的保护因素。Objective To explore risk factors of severe postpartum hemorrhage of placenta previa in patients with placenta previa in order to reduce the incidence.Methods From January 2018 to September 2022,pregnant women who dilivered due to“placenta previa”fits into the exclusion criteria were selected as research objects.Patients relevant information were collected.According to the volume of 24-hour postpartum bleeding they were divided into two groups,bleeding volume<1000 ml group and≥1000 ml group.Risk factors were analyzed that caused severe postpartum hemorrhage,significant risk factors were identified by univariate analysis,the correlation factors were analyzed by multivariate Logistic regression model,finally the prediction model of severe postpartum hemorrhage in patients with placenta previa was established.Results In this study,there were total 364 research objects,including 114 cases bleeding volume≥1000 ml.There were 36 variables analyzed through univariate analysis,the results showed that test statistics of 12 variables were statistically significant(P<0.05),indicating that they were risk factors for severe postpartum hemorrhage in patients with placenta previa.12 variables included age,the number of pregnancy times,the number of delivery times,the number of cesarean delivery times,previous history of preterm delivery,previous history of uterine surgery,placenta attachment site of this pregnancy,intraoperative placenta situation,method of termination of pregnancy,type of anesthesia,method of intraoperative hemostatic suture,use of uterine contraction promoting drugs,etc.Logistic regression model analysis showed that adherent placenta(OR=3.164,95%CI 1.704~5.873),placenta accreta(OR=6.138,95%CI 2.640~14.273),the number of cesarean delivery times(1 time)(OR=2.426,95%CI 1.378~4.273)and general anesthesia(OR=4.103,95%CI 2.145~7.847)were risk factors for severe postpartum hemorrhage.Conclusion The factors(the number of previous cesarean delivery times,adherent placenta,placenta accreta and general anesthesia

关 键 词：前置胎盘 产后出血 胎盘植入 

分 类 号：R714.461[医药卫生—妇产科学]