阴道分娩前后血红蛋白与出血量的关系研究

A prospective observational study of the change of hemoglobin value and the blood loss before and after vaginal delivery

目的探讨产后血红蛋白变化与阴道出血量之间的关系。方法前瞻性随机选取2017年12月至2018年1月在北京大学第三医院产科住院阴道分娩的200例孕妇(除外血液系统疾病、妊娠期高血压疾病及产前出血)。按产后2 h出血量分为轻度出血组(产后2 h出血小于400 ml)、中度出血组(产后2 h出血400～1 000 ml)、重度出血组(产后2 h出血大于等于1 000 ml)。分别比较各组在产后2 h及产后24 h血红蛋白等指标变化情况。结果轻度出血组及中度出血组在产后2 h实际血红蛋白变化值与理论血红蛋白变化值差异无统计学意义(P>0.05),而产后24 h差异有统计学意义[15(10, 21) vs 9(8, 10)],[30(20, 34) vs 15(14, 18)](P <0.05)。重度出血组在产后2 h实际血红蛋白变化值与理论血红蛋白变化值差异有统计学意义[3(-4, 21) vs 28(24, 31)](P <0.05),而产后24 h差异无统计学意义(P>0.05)。结论产后失血量程度不同的产妇,产后血红蛋白变化与阴道失血量关系不同:阴道分娩后2 h内出血低于1 000 ml者产后24 h血红蛋白变化与失血量不相符,而严重产后出血者产后2 h的血红蛋白变化不能准确评估阴道失血量。

Objective To investigate the consistency of the change of hemoglobin value and vaginal blood loss after vaginal delivery. Methods 200 pregnant women(excluding hematonosis, hypertensive disorders in pregnancy and prenatal bleeding) were selected randomly from December 2017 to January 2018 in obstetric department of Peking University Third Hospital and divided into three groups: mild blood loss group(the blood loss within 2 hours after vaginal delivery < 400 ml), moderate blood loss group(400 ~ 1 000 ml), and severe blood loss group( ≥ 1 000 ml).The changes of hemoglobin value on 2 hours and 24 hours after vaginal delivery were compared. Results There was no significant difference between the change of actual hemoglobin value and the change of theoretical hemoglobin value on 2 hours after vaginal delivery in both of mild and moderate blood loss groups(P > 0.05), while the difference was statistically signiícant in both of mild and moderate blood loss groups: [15(10, 21) vs 9(8, 10)], [30(20, 34) vs 15(14, 18)](P < 0.05). There was no signiícant difference between the change of actual hemoglobin value and the change of theoretical hemoglobin value on 24 hours after vaginal delivery in severe blood loss group(P > 0.05), while the difference was statistically signiícant in severe blood loss group: [3(-4, 21) vs 28(24, 31)](P < 0.05). Conclusions The relationship between hemoglobin change and vaginal hemorrhage was different in women with different degree of postpartum hemorrhage. The change of hemoglobin was not consistent with the amount of hemorrhage 24 hours after vaginal delivery in those with hemorrhage less than 1 000 ml within 2 hours, while the change of hemoglobin in severe postpartum hemorrhage could not accurately evaluate the amount of vaginal blood loss 2 hours after delivery.