剖宫产后妊娠人工流产术中大出血因素分析及预测模型  

Analysis of the influencing factors and the prediction model of the massive hemorrhage during induced abortion of women with unwanted pregnancy after cesarean section

作　　者：郭颖 宁飞燕 GUO Ying;NING Feiyan(Luoyang Maternal and Child Health Care Hospital,Luoyang,Henan Province,471000)

机构地区：[1]河南省洛阳市妇幼保健院,471000

出　　处：《中国计划生育学杂志》2024年第12期2861-2866,共6页Chinese Journal of Family Planning

摘　　要：目的:探讨剖宫产后妊娠人工流产术中大出血有关因素,构建并评价预测模型。方法:选取2021年2月-2024年2月本院就诊的剖宫产后意外妊娠行人工流产术者300例临床资料,按照7:3比例分为建模集(210例)与验证集(90例),依据术中有无出现大出血分为术中大出血组与非大出血组。收集患者临床资料,采用logistic回归分析术中大出血影响因素,依据独立影响因素构建预测模型,受试者操作特征(ROC)曲线评价预测模型效能,H-L检验预测模型的校准度。结果:300例均顺利实施人工流产,建模集因个人因素退出2例、资料收集不全4例,纳入204例;验证集资料收集不全1例,纳入89例;共纳入293例。293例术中大出血发生率为24.6%(72/293),其中建模集术中大出血发生率为24.0%(49/204),验证集术中大出血发生率为25.8%(23/89)。建模集中大出血组与非大出血组年龄、剖宫产次数、距离末次剖宫产时间、子宫前壁下段肌层厚度、胚胎停育情况、孕囊平均直径、孕囊距瘢痕距离等均有差异(均P<0.05)。logistic回归分析显示,年龄≥35岁、剖宫产≥2次、距离末次剖宫产时间短、子宫前壁下段肌层厚度小、孕囊平均直径大、孕囊距瘢痕距离短是剖宫产后意外妊娠行人工流产术中大出血的危险因素(均P<0.05)。绘制ROC曲线显示,建模集根据列线图预测术中大出血的风险的曲线下面积(AUC)为0.955,验证集AUC为0.896。建模集、验证集校准曲线均显示预测曲线与理想曲线接近,具有较好一致性。结论:孕妇年龄大、剖宫产次数、孕囊平均直径大、孕囊距瘢痕距离短、距离末次剖宫产时间短、子宫前壁下段肌层厚度小均可影响剖宫产后意外妊娠人工流产者术中大出血的发生,据此构建的预测模型有良好的预测效能、校准度,有助于临床早期预防与处理。Objective:To investigate the factors influencing of the massive hemorrhage during induced abortion of women with unwanted pregnancy after cesarean section,and to construct and evaluate the prediction model for the massive hemorrhage based on these influence factors.Methods:From February 2021 to February 2024,the clinical data of 300 women with unwanted pregnancy after cesarean section in the hospital were selected in this study.According to the ratio of 7:3,these patients were divided 210 cases for the setting model and 90 cases for the validation set.According to the presence or absence of the intraoperative massive hemorrhage,these women were divided into group A(women with intraoperative massive hemorrhage)and group B(women without intraoperative massive hemorrhage).The clinical data of these women were collected,and the influencing factors of the intraoperative massive hemorrhage of the women were analyzed by logistic regression.The prediction model was constructed according to the independent influencing factors of the intraoperative massive hemorrhage of the women.Receiver operating characteristic(ROC)curve was used to evaluate the efficacy of this prediction model for predicting of the intraoperative massive hemorrhage of the women,and the H-L test was used to test the calibration of this prediction model.Results:3oo women with unplanned pregnancy after cesarean section were induced abortion successfully.2 cases were withdrawn from the setting model due to their personal factors,there were 4 women without the complete data collected,and so 204 women were included for the setting model.There was 1 case without the complete data collected,and so 89 cases were included for the validation set.Finally,the data of 293 women were included in this study.The incidence of the intraoperative massive hemorrhage of 293 women was 24.6%(72/293),and among them,there were 24.0%(49/204)women for the modeling set and 25.8%(23/89)women for the verification set.There were no significant differences in the age,the times of cesa

关 键 词：剖宫产后妊娠 人工流产术 术中大出血 影响因素 预测模型 

分 类 号：R169.42[医药卫生—公共卫生与预防医学]