高龄产妇产后出血量≥500 ml的危险因素分析及Nomogram模型构建和预测能力验证  

Analysis on the risk factors of postpartum bleeding equal or greater than 500 ml for elderly parturient women and Nomogram model construction and prediction validation

作　　者：莫洋洋 杨飞 MO Yang-yang;YANG Fei(Parturition Center,Hangzhou Obstetrics and Gynecology Hospital,Hangzhou Maternal and Child Health Care Hospital,Hangzhou,Zhejiang 310030,China)

机构地区：[1]杭州市妇产科医院(杭州市妇幼保健院)分娩中心,浙江杭州310030

出　　处：《中国妇幼保健》2025年第2期278-282,共5页Maternal and Child Health Care of China

基　　金：浙江省卫生健康科技计划项目(2022RC062)。

摘　　要：目的 通过Nomogram模型预测高龄产妇产后出血量≥500 ml的发生风险,为产科及时采取针对性防控策略,降低产后出血发生风险提供依据。方法 选取2019年1月—2023年1月在杭州市妇产科医院分娩的1 358例高龄产妇作为研究对象,分为观察组(产后出血量≥500 ml)和对照组(产后出血量<500 ml)。采用LASSO回归分析、logistic回归分析筛选高龄产妇产后出血量≥500 ml的独立危险因素,采用R(R 3.5.3)软件建立预测高龄产妇产后出血量≥500 ml的Nomogram模型,以受试者工作特征(ROC)曲线、决策曲线、校正曲线对Nomogram模型的预测价值、临床效用进行验证,并进一步进行重要性矩阵分析。结果 1 358例高龄产妇产后出血量≥500 ml者有120例,其中早期出血104例,晚期出血16例,平均出血量为(1 267.58±332.29)ml。多因素logistic回归分析显示:前置胎盘、妊娠期高血压疾病、巨大儿、瘢痕子宫、宫缩乏力、焦虑自评量表(SAS)评分、D-二聚体是高龄产妇产后出血量≥500 ml的危险因素。校正曲线显示:模型一致性指数(C-index)为0.871(95%CI:0.865~0.978),校正曲线与理想曲线基本一致;ROC曲线下面积(AUC)为0.951(95%CI:0.896~0.971);宫缩乏力、SAS评分、妊娠期高血压疾病、瘢痕子宫、巨大儿等因素的重要性较高,改善难度较低,进入优先改进区域。结论 瘢痕子宫、SAS评分、前置胎盘、D-二聚体、妊娠期高血压疾病、巨大儿、宫缩乏力是高龄产妇产后出血量≥500ml的影响因素,临床可据此制定针对性防治措施,进一步改善预后。Objective To predict the risk of postpartum hemorrhage equal or greater than 500 ml for elderly parturient women byNomogram model, provide a basis for prevention and control strategies in obstetric department and reduce postpartum hemorrhage risk.Methods A total of 1 358 elderly parturient women who gave birth in Hangzhou Obstetrics and Gynecology Hospital from January 2019 toJanuary 2023 were selected as research objects.According to whether postpartum blood loss equal or greater than 500 ml, they were dividedinto observation group (equal or greater than 500 ml) and control group (less than 500 ml) .LASSO analysis and logistic regression analysiswere used to screen independent risk factors of postpartum blood loss equal or greater than 500 ml for elderly parturient women.R (R3.5.3) software was used to establish Nomogram model for the prediction of postpartum blood loss equal or greater than 500 ml.Receiver operatingcharacteristic (ROC) curve, decision curve, and calibration curve were used to verify the prediction value and clinical efficacy of Nomogrammodel, and importance matrix analysis was conducted.Results There were 120 cases with postpartum bleeding equal or greaterthan 500 ml in 1 358 elderly parturient women, including 104 cases with early hemorrhage and 16 cases with late hemorrhage.The averageblood loss was (1 267.58±332.29) ml.Multivariate logistic regression analysis showed that placenta previa, hypertensive disorder complicatingpregnancy, macrosomia, cicatricial uterus, contraction fatigue, Self-rating Anxiety Scale (SAS) score, and D-dimer were risk factorsfor postpartum bleeding equal or greater than 500 ml.Correction curve showed that the model consistency index (C-index) was 0.871 (95%CI: 0.865-0.978), and correction curve was basically consistent with the ideal curve.The area under ROC curve (AUC) was 0.951 (95%CI: 0.896-0.971) .Uterine fatigue, SAS score, hypertensive disorder complicating pregnancy, cicatricial uterus, and macrosomia were ofhigh importance, and the difficulty of improvemen

关 键 词：高龄产妇 产后出血量 危险因素 模型构建 

分 类 号：R714.6[医药卫生—妇产科学]