产科急症子宫切除相关危险因素Logistic回归分析

Logistic regression analysis of related risk factors of obstetric emergency hysterectomy

目的探讨产科急症子宫切除的发生率、产科急症子宫切除的危险因素。方法回顾性分析商丘市4家市级医院分娩产妇病历资料，将80例行产科急症子宫切除患者作为子宫切除组，按随机数字表法随机抽取同期56例剖宫产产后出血子宫未切除患者作为对照组，分析与产科急症相关的危险因素。结果（1）分娩总人数共65259例，剖宫产率为47．46％（30972／65259），剖宫产产后出血率为4．61％（1429／30972），剖宫产子宫切除率为0．18％（56／30972），阴道分娩产后出血率3．28％（1124／34287），院内阴道分娩急症子宫切除率为0．03％（12／34287），剖宫产产后出血率及产科急症子宫切除率均高于阴道分娩产后出血率及子宫切除率，差异有统计学意义（x^2=77．22、33．24，均P〈0．05）。（2）单因素分析，前置胎盘并植入、胎盘早剥、合并多发或巨大子宫肌瘤、子宫破裂、凝血功能障碍、出血量〉2000ml、术中联用缩宫素率在两组之间均差异有统计学意义（P〈0．01）。（3）非条件多因素Logistic回归分析，胎盘早剥、子宫破裂、合并多发或巨大子宫肌瘤、凝血功能障碍、出血量〉2000ml是导致产科急症子宫切除的独立危险因素，术中联用缩宫素与切除子宫之间具有负相关，是保护因素。结论产科急症行子宫切除术与多种因素相关，加强围产期保健，积极预防急症子宫切除术的危险凶素对降低子宫切除率具有重要意义。

Objective To investigate the incidence rate and risk factors of obstetric emergency hysterectomy. Methods The clinical data of childbirth puerpera in Shangqiu four municipal hospitals were retrospectively analyzed,80 patients underwent routine obstetric emergency hysterectomy were selected as hysterectomy group,56 post-partum hemorrhage patients without uterus excision were randomly selected as control group. The related risk factors of obstetric emergency were analyzed. Results （ 1 ） The total delivery number was 65 259 cases, cesarean rate was 47.46% （30 972/65 259）, postpartum hemorrhage rate was 4.61% （ 1 429/30 972）, and uterus removal rate of cesarean section was 0.18% （56/30 972）, vaginal delivery postpartum hemorrhage rate was 3.28% （ 1 124/34 287 ）, in the courtyard the vaginal delivery emergency uterus removal rate was 0.03% （ 12/34 287）. The postpartum hemor-rhage rate and obstetrics emergency uterus removal rate were higher than vaginal delivery, the differences were statisti- cally significant （X62 = 77.22,33.24, all P 〈 0.05 ）. （2）The results of the single factor analysis showed that, placenta previa and implant, placental abruption, merge multiple or huge uterine fibroids, uterine rupture, blood coagulation dys- function, amount of bleeding 〉 2 000ml, vanda operation with oxytocin rate between the two groups, there were signifi- cant differences （P 〈 0.01 ）. （3）The results of unconditional multi-factor Logistic regression analysis showed that, pla- cental abruption, uterine rupture, merge multiple or huge uterine fibroids, blood coagulation dysfunction, amount of bleeding 〉 2 000ml were independent risk factors which lead to obstetric emergency hysterectomy. Vanda operation with oxytocin and hysterectomy had negative correlation. Conclusions Obstetric emergency hysterectomy was related with a variety of factors. Strengthen the perinatal health care, and actively prevent emergency hysterectomy can reduce the dangerous factors of uterus removal rate and has important significance.