基层严重产后出血影响因素分析

An analysis of influencial factors of severe postpartum hemorrhage in local hospitals

目的分析基层严重产后出血影响因素，探讨减少基层严重产后出血发生的防治措施。方法采用1：1匹配的病例对照研究，选取河南某县4所二级医院2006年1月1日至2007年12月31日所有符合严重产后出血和产后出血诊断标准的病例。采用自行设计的病历调查表，从病历中收集相关信息。通过非条件多因素Logistic回归分析方法探讨各相关因素与严重产后出血的作用关系。结果单因素分析显示：病例组各因素（年龄≥35岁，流产次数≥2次，末次分娩年限≥10年，产前出血，中、重度贫血，胎盘异常，不良产程干预，产前宫缩剂的应用等）比例明显高于对照组（X2分别为41．937、18．400、5．412、7．612、11．930、22．962、5．031、22．430，均P〈0．05）。多因素Logistic回归分析显示：正常待产中宫缩剂应用（OR=14．293）、流产≥2次（OR=11．374）、胎盘异常（OR=7．081）、剖宫产（OR=5．389）是严重产后出血的危险因素。产后出血诊断明确后，及时应用欣母沛（OR=0．026）对严重产后出血的发生有保护作用。结论通过分析基层严重产后出血孕期、产时的暴露因素，为制定基层严重产后出血防治措施提供了科学依据。

Objective To investigate influencial factors of severe postpartum hemorrhage in local hospitals, and to explore prevention and treatment to reduce incidence of severe postpartum hemorrhage. Methods In 1 ： 1 matched case-control study method, all women who met the diagnostic creteria of severe postopartum hemorrhage or postopartum hemorrhage in 4 Class Ⅱ hospitals in a county of Henan province over a period from 1/January, 2006 to 31/ december, 2007 were selected. A self-designed questionnaire was used to collect relevant information of postpartum hemorrhage from case record of the patient. Non-conditioned logistic regression analysis was conducted to analyze relationships of those factors with severe postpartum hemorrhage. Results Single factor analysis showed that all factors such as age of the parturient ≥ 35 years, frequency of abortion ≥2, over 10 years from last delivery to now, prenatal hemorrhage, moderate and severe anemia in pregnancy, placental abnormalities, adverse interventions in labor process in the case group were significantly higher than those in the control group （X2 =41. 937, 18. 400, 5. 412, 7. 612, 11. 930, 22. 962, 5. 031and 22. 430 respectively,all P 〈0.05）. Multi-factorial logistic regression showed that use of oxytocin in predelivery （OR = 14. 293 ）, frequency of abortion ≥2 （OR = 11. 374 ）, placental abnormalities （OR =7. 081 ） and cesarean section （OR = 5. 389） were important risk factors of severe postpartum hemorrhage. When the diagnosis of postopartum hemorrage was determined, timely use of carboprost tromethamine （ OR = 0. 026 ） was a protective factor. Conclusion Analysis of antepartum and intrapartum risk factors of severe postopartum hemorrhage provids a scientific basis for working out strategies to prevent and treat severe postpartum hemorrhage in the local hospitals.