阴道分娩产后出血量的影响因素分析及风险预警模型构建  

Analysis of factors affecting postpartum blood loss after vaginal delivery and construction of a risk early-warning model

作　　者：国文慧 周建伟 毕琳 GUO Wen-hui;ZHOU Jian-wei;BI Lin(Dalian Women and Children Medical Center(Group),Dalian 116021,China)

机构地区：[1]大连市妇女儿童医疗中心(集团),116021

出　　处：《中国现代药物应用》2025年第3期1-6,共6页Chinese Journal of Modern Drug Application

摘　　要：目的探讨阴道分娩产后出血量的影响因素,构建预测阴道分娩产后出血量的风险预警模型,为制定临床早期干预方案提供科学依据。方法选取1000例阴道分娩产妇作为研究对象,调查产后出血量的相关因素,分析阴道分娩产后出血量的现状及影响因素,运用多重线性逐步回归构建阴道分娩产后出血量的风险预警模型,采用受试者工作特征曲线(ROC曲线)评估风险预警模型的预测效果。结果1000例产妇平均年龄为(31.05±3.74)岁,孕前平均体质量指数(BMI)为(21.63±3.55)kg/m^(2),平均身高为(165.22±4.54)cm。阴道分娩产后出血发生率为6.5%(65/1000),产后出血量为(325.76±104.33)ml。单因素分析发现:不同文化程度、孕次、胎次、胎盘娩出方式及是否有先兆早产史、手取胎盘术、会阴裂伤Ⅰ度、会阴左侧切开、会阴切开指征、宫颈裂伤、胎盘完整产妇产后出血量比较差异具有统计学意义(P<0.05)。Pearson相关分析显示:总产程、第一产程和第二产程与产后出血量呈正相关(P<0.05)。多重线性逐步回归分析(后退法)结果显示:先兆早产史、胎盘娩出方式、会阴裂伤Ⅰ度、宫颈裂伤、第一产程、第二产程是影响阴道分娩产后出血量的主要相关因素(P<0.05)。从而得出回归方程:Y(估计)=275.90-30.98先兆早产史-51.16会阴裂伤Ⅰ度+40.87胎盘娩出方式+49.65宫颈裂伤+0.03第一产程+0.32第二产程。风险预警模型的ROC曲线下面积(AUC)为0.779[95%CI=(0.746,0.813)],模型具有较好的预测效果。结论阴道分娩产后出血的发生率处于中等水平。为保障母婴安全,减少产后出血的发生,当产后出血量>400 ml时,医护人员应及时给予相应的干预措施。因此,医护人员应提高警惕,针对可能引起出血的危险因素制定个性化诊疗方案及应急预案,提前干预。Objective To explore the influencing factors of postpartum blood loss after vaginal delivery and build a risk early-warning model for predicting postpartum blood loss,so as to provide scientific basis for the formulation of clinical early intervention plan.Methods A total of 1000 women with vaginal delivery were selected as the research subjects to investigate the related factors of postpartum blood loss,analyze the status quo and influencing factors of postpartum blood loss.Stepwise multiple linear regression was used to construct a risk early-warning model for postpartum blood loss,and receiver operating characteristic(ROC)curve was used to evaluate the prediction effect of the risk early-warning model.Results The average age of the 1000 women was(31.05±3.74)years,the average pre-pregnancy body mass index(BMI)was(21.63±3.55)kg/m^(2) and the average height was(165.22±4.54)cm,the incidence of postpartum hemorrhage after vaginal delivery was 6.5%(65/1000)and the postpartum blood loss was(325.76±104.33)ml.Univariate analysis showed that there were statistically significant differences in postpartum blood loss among women with different education levels,gravidity and parity history,mode of placenta delivery,history of threatened premature delivery,manual placenta extraction,Ⅰdegree perineal laceration,left perineal incision,indications of perineal incision,cervical laceration and placenta intact(P<0.05).Pearson correlation analysis showed that the total duration of labor,the duration of first stage of labor and the duration of second stage of labor were positively correlated with postpartum blood loss(P<0.05).Stepwise multiple linear regression analysis(regression method)showed that history of threatened premature delivery,mode of placenta delivery,Ⅰ degree perineal laceration,cervical laceration,duration of first stage of labor,duration of second stage of labor were the main related factors affecting the postpartum blood loss(P<0.05).This resulted in the regression equation:Y^(Estimated)=275.90-30.98 histor

关 键 词：阴道分娩 产后出血量 多重线性逐步回归 风险预警模型 

分 类 号：R714.461[医药卫生—妇产科学]