36例严重产后出血影响因素分析

An analysis of influential factors of severe postpartum hemorrhage in Local hospitals

目的:针对我院严重产后出血探讨减少基层医院严重产后出血的发生的防治措施。方法:选择本院2005年1月至2009年5月存档病案,从病历中取集相关信息,所有病历均符合严重产后出血和产后出血诊断标准,通过非条件因素Logistic回归分析方法探讨各相关因素与严重产后出血的关系。结果:单因素分析显示:病例组各因素(年龄≥33岁,流产次数≥2次,末次分娩年限≥7年,产前出血,中重度盆血,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值分别为39.937,14.400,4.412,6.612,9.930,9.962,10.031,24.430,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=12.293),流产≥2次(OR=13.374),胎盘异常(OR=10.081),剖宫产(OR=3.389)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=0.066)对严重产后出血的发生有保护作用。结论:孕期、产时的相关暴露因素是引起严重产后出血的重要危险因子,本研究为制定我院严重产后出血防治措施提供了科学依据。

Objective ：To investigate influential factors of Severe postpartum hemorrhage in local hospital, and to explore pre- vention and treatment to reduce incidence of severe postpartum hemorrhage. Methods：In 1 ： 1 matched case - control study method,all women who met the diagnostic criteria of severe post partum hemorrhage or postpartum hemorrhage our hospital in a county of Gd. Over a period from 1/January,2005 to 31/May,2009 wore 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 rela- tionships of those factors with severe postpartum hemorrhage. Results： Single factors analysis showed that all factors such as age of the parturient~〉33years ,frequency of abortion I〉2, over7years from last delivery to now, prenatal hemorrhage, moderate and severe anemia in pragnaney, placental abnormalities, adverse interventions in labor process in the case group were significantly higher than those in the control group （x2 - 39.937 ; 14.400 ;4.412 ;6.612 ;9.930 ;9. 962 ; 10.031 and24.430respectively, all P 〈 0.05. Multi - factorial logistic regression showed that use of oxytocin in predelivery （OR = 12. 293 ）, frequency of abortion~〉 （OR = 13. 374 ）, placental abnormalities （ OR = 10. 081 ） and eesarean section（ OR = 3. 389） were important risk factors of severe postpartum hemorrhage. When the diagnosis of post partum hemorrhage was determined, timely use of carboprost tromethamiue （ OR = 0. 066） was a protective factor. Conclusions： Analysis of ante partum and intrapartum risk factors of severe postpartum hemorrhage provides a scientific basis for working out strate- gies to prevent and treat severe postpartum hemorrhage in our hospital.