ISO9001管理体系预防高危孕妇剖宫产术后出血的临床研究

The clinical research of ISO9001 management system in preventing cesarean postpartum hemorrhage of high risk pregnant women

目的:探讨ISO9001管理体系在预防剖宫产特别是高危孕妇剖宫产术后出血的作用,以降低产后出血的发生。方法:借鉴ISO9001管理理念对本院2010年4～11月间住院并以剖宫产结束分娩的744例产妇进行统一的产后出血预测评分,并根据预测评分情况分为低危组(0～4分)276例、中危组(5～7分)317例、高危组(>7分)151例进行分级防治。结果:预测评分与各阶段产后出血量正相关。术中出血、术后2 h出血低危组低于中危组及高危组(P<0.05),但中危组与高危组之间比较无差异(P>0.05);产后出血发生率中危组高于低危组(P<0.05),但中危组与高危组比较无差异(P>0.05);未经规范预防的阴道分娩产后出血≥2 000 ml发生率明显高于剖宫产分娩(P<0.05)。结论:ISO9001管理体系能有效地防治高危孕妇剖宫产术后出血特别是严重的产后出血发生,值得推广。

Objective：To discuss the effect of ISO9001 management system in preventing cesarean postpartum hemorrhage especially in high risk pregnant women in order to reducing the happening of postpartum hemorrhage.Methods：Using ISO9001 management system for reference,forecasting grade postpartum hemorrhage of 744 cases of cesarean section in our hospital from April 2010 to November 2010,and classified them into low-risk（0-4 points）,medium-risk（5-7 points） and high-risk（7 points） groups by the effect of postpartum hemorrhage predictor score to prevent and cure.Results：Predictor score was significantly positively associated with the amout of postpartum hemorrhage in each group.The hemorrhage intraoperative and 2 hours after delivery low-risk group was lower than medium-risk and high-risk groups（P0.05） which had no difference between the latter two groups（P0.05）;postpartum hemorrhage rate of medium-risk group was higher than that of low-risk group（P0.05）,and there was no difference between medium-risk and high-risk groups;The postpartum hemorrhage rate ≥2 000 ml of non-standard prevention and cure vaginal delivery was higher than cesarean.Conclusion：ISO9001 management system can effectively prevent the happening of cesarean postpartum hemorrhage especially severe postpartum hemorrhage,and it is worthy of popularization in clinic.