前置胎盘孕妇产前止凝血功能及与产后出血的关系  

Relationship between prenatal coagulation function and postpartum hemorrhage in pregnant women with placenta previa

作　　者：王平 杨丽娟 高敏 尚小燕 谷运娜 王桂芳 杨华丹 Wang Ping;Yang Lijuan;Gao Min;Shang Xiaoyan;Gu Yunna;Wang Guifang;Yang Huadan(Department of Obstetrics and Gynecology,People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture,Aba Sichuan 624000,China;Department of Obstetrics and Gynecology,Affiliated Hospital of University of Electronic Science and Technology of China,Chengdu 610072,China;Department of Surgery,People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture,Aba Sichuan 624000,China)

机构地区：[1]四川省阿坝藏族羌族自治州人民医院妇产科,四川阿坝624000 [2]电子科技大学附属医院妇产科,成都610072 [3]四川省阿坝藏族羌族自治州人民医院外科,四川阿坝624000

出　　处：《保健医学研究与实践》2024年第10期48-54,共7页Health Medicine Research and Practice

基　　金：四川省科技计划项目(2022YJ0157)。

摘　　要：目的探讨前置胎盘(PP)孕妇产前止凝血功能与产后出血的关系,以期为PP孕妇产后出血风险预测及干预提供参考。方法选择2019年3月—2023年3月阿坝藏族羌族自治州人民医院收治的136例PP孕妇纳入PP组,另选择同期于医院产检的136例健康孕妇纳入对照组,比较2组孕妇产前止凝血功能指标[活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)和D-二聚体(D-D)]水平。根据是否发生产后出血将PP孕妇分为出血组(66例)和未出血组(70例),比较2个亚组孕妇产前止凝血功能。绘制受试者工作特征(ROC)曲线分析PP孕妇产前APTT、FIB和D-D水平及三者联合对PP孕妇产后出血的预测价值;采用多因素logistic回归分析PP孕妇产后出血的影响因素。结果PP组孕妇产前APTT长于对照组,血清FIB水平高于对照组,D-D水平低于对照组,差异均有统计学意义(P<0.05)。出血组PP孕妇产前APTT长于未出血组,血清FIB水平高于未出血组,D-D水平低于未出血组,差异均有统计学意义(P<0.05)。联合检测血清APTT、FIB和D-D水平预测PP孕妇产后出血的AUC为0.942(95%CI:0.904~0.981),高于单个指标检测(P<0.05)。出血组PP孕妇流产次数≥3次、怀孕次数≥3次、术中出血量≥528.36 mL、未使用介入技术、发生胎盘粘连、完全性PP类型、APTT≥32.494 s、FIB水平≥4.048 g/L、D-D水平≤1.867 mg/L的比例高于未出血组,差异有统计学意义(P<0.05)。logistic多因素回归分析结果显示,流产次数≥3次(OR=1.369;95%CI:1.101~1.702)、胎盘粘连(OR=2.100;95%CI:1.070~4.122)、术中出血量≥528.36 mL(OR=1.024;95%CI:1.006~1.043)、APTT≥32.494 s(OR=1.539;95%CI:1.012~2.341)、FIB水平≥4.048 g/L(OR=2.071;95%CI:1.317~3.257)和D-D水平≤1.867 mg/L(OR=3.916;95%CI:1.534~9.993)是PP孕妇产后出血的独立危险因素(P<0.05)。结论PP孕妇产前止凝血功能处于异常状态,且相较于无产后出血孕妇,产后出血孕妇的产前止凝血功能更差;血清APTT、FIB和DObjective To investigate the relationship between prenatal coagulation function and postpartum hemorrhage in pregnant women with placenta previa(PP),aiming to provide a reference for risk prediction and intervention of postpartum hemorrhage in them.Methods A retrospective analysis was conducted on 136 pregnant women with PP admitted to our hospital from March 2019 to March 2023,who were included in the PP group,and 136 healthy pregnant women who underwent prenatal check-ups at the hospital during the same period were included in the control group.The levels of prenatal coagulation function indicators[activated partial thromboplastin time(APTT),fibrinogen(FIB),and D-dimer(D-D)]were compared between the two groups.Pregnant women with PP were further allocated to a bleeding group(66 cases)and a non-bleeding group(70 cases)based on the presence or absence of postpartum hemorrhage,and the prenatal coagulation function was compared between the two subgroups.The receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of prenatal APTT,FIB,and D-D levels and their combination for postpartum hemorrhage in pregnant women with PP;multivariate logistic regression analysis was used to identify the influencing factors of postpartum hemorrhage in these individuals.Results The prenatal APTT in the PP group was significantly longer than that in the control group,the serum FIB level was significantly higher than that in the control group,and the D-D level was significantly lower than that in the control group(P<0.05).The prenatal APTT in the bleeding group of pregnant women with PP was significantly longer than that in the non-bleeding group,the serum FIB level was significantly higher than that in the nonbleeding group,and the D-D level was significantly lower than that in the non-bleeding group(P<0.05).The area under the curve(AUC)for predicting postpartum hemorrhage in pregnant women with PP by combined detection of serum APTT,FIB,and D-D levels was 0.942(95%CI:0.904-0.981),which was higher than t

关 键 词：前置胎盘 止凝血功能 出血风险 相关性 危险因素 预测价值 

分 类 号：R714.461[医药卫生—妇产科学]