胎盘粘连的风险因素分析及临床治疗方案研究  

Analysis of Risk Factors and Clinical Treatment of Placental Adhesions

作　　者：康连风 曹春风 宋金妹 KANG Lianfeng;CAO Chunfeng;SONG Jinmei(Obstetrics Department of Xinfeng County People's Hospital,Xinfeng 341600,Jiangxi,China)

机构地区：[1]信丰县人民医院产科,江西信丰341600

出　　处：《医学信息》2024年第19期114-117,121,共5页Journal of Medical Information

基　　金：赣州市指导性科技计划项目(编号:GZ2023ZSF638)。

摘　　要：目的 探究胎盘粘连的危险因素及理想治疗方案。方法 以2022年5月-2023年11月信丰县人民医院经阴道分娩的100例产妇为研究对象,依据其胎盘粘连发生情况分为胎盘粘连组与未发生胎盘粘连组,收集两组基本信息及病理检查结果,分析胎盘粘连的危险因素,构建相关列线图预测模型,并予以验证。采用随机数字表法,将胎盘粘连组患者分为A组与B组,A组给予缩宫素脐静脉注射,B组行马来酸麦角新碱肌内注射,比较两组治疗效果。结果 胎盘粘连组产妇共38例,未发生胎盘粘连组62例;两组年龄、妊娠合并症、产次、剖宫产史、流产史、胎盘厚度、胎盘长度、胎盘宽度比较,差异有统计学意义(P<0.05)。多因素Logistic分析显示,年龄、剖宫产史、流产史、胎盘厚度、胎盘长度、胎盘宽度均是影响胎盘粘连发生的独立危险因素(P<0.05)。依据上述危险因素建立胎盘粘连的列线图预测模型,经ROC曲线验证,该模型区分度AUC=0.807(95%CI:0.752~0.843),且校准曲线显示校准曲线斜率接近1,模型预测效果良好。胎盘粘连组经治疗后,A组胎盘自然剥离率高于B组,手取胎盘率低于B组(P<0.05)。结论 产妇年龄、剖宫产史、流产史与胎盘厚度、长度、宽度是导致胎盘粘连发生的危险因素,基于以上因素构建的列线图预测模型具有较好的预测效能,经脐静脉注射缩宫素在该病治疗中具有良好的临床效果。Objective To explore the risk factors and ideal treatment of placental adhesion.Methods From May 2022 to November 2023,100 parturients who underwent vaginal delivery in Xinfeng County People's Hospital were selected as the research objects.According to the occurrence of placental adhesion,they were divided into placental adhesion group and non-placental adhesion group.The basic information and pathological examination results of the two groups were collected,the risk factors of placental adhesion were analyzed,and the relevant nomogram prediction model was constructed and verified.The patients in the placental adhesion group were divided into group A and group B by random number table method.Group A was given oxytocin umbilical vein injection,and group B was given ergometrine maleate intramuscular injection.The therapeutic effects of the two groups were compared.Results There were 38 cases in the placental adhesion group and 62 cases in the non-placental adhesion group.There were significant differences in age,pregnancy complications,parity,cesarean section history,abortion history,placental thickness,placental length and placental width between the two groups(P<0.05).Multivariate logistic analysis showed that age,history of cesarean section,history of abortion,placental thickness,placental length and placental width were independent risk factors for placental adhesion (P<0.05).According to the above risk factors,a nomogram prediction model of placental adhesion was established.The ROC curve showed that the model discrimination AUC=0.807(95%CI:0.752-0.843),and the calibration curve showed that the slope of the calibration curve was close to 1,and the model prediction effect was good.After treatment,the natural placental detachment rate in group A was higher than that in group B,and the rate of taking placenta by hand was lower than that in group B(P<0.05).Conclusion Maternal age,history of cesarean section,history of abortion and placental thickness,length and width are risk factors for placental adhesion.The nom

关 键 词：胎盘粘连 危险因素 预测模型 胎盘厚度 缩宫素 胎盘自然剥离 

分 类 号：R714[医药卫生—妇产科学]