产后出血导致产科急症子宫切除术的高危因素分析

Analysis on the Risk Factors of Postpartum Hemorrhage Causing Obstetric Emergency Hysterectomy

目的分析产后出血导致产科急症子宫切除术的高危因素。方法回顾性分析2008年4月至2014年9月北京市顺义区医院产科收治的110例产后出血患者的临床资料,均符合产后出血的相关诊断标准,其中56例行急症子宫切除术治疗的患者作为观察组,54例未行急症子宫切除术的患者作为对照组。对比两组患者的临床资料,筛选高危因素。结果单因素分析显示,观察组胎盘早剥、胎盘植入、前置胎盘和弥散性血管内凝血(DIC)的发生率显著高于对照组[17.9%(10/56)比1.9%(1/54),19.6%(11/56)比3.7%(2/54),35.7%(20/56)比11.1%(6/54);25.0%(14/56)比7.4%(4/54)],差异有统计学意义(P<0.05);Logistic多因素回归分析显示,前置胎盘、胎盘早剥、胎盘植入和DIC是子宫切除术的高危因素(P<0.05)。结论急症子宫切除术与多种危险因素有关,需严格掌握子宫切除指征和时机选择,加强围生期宣传教育,减少子宫切除术的发生,提高分娩质量。

Objective To analyze on the risk factors of postpartum hemorrhage causing obstetric emergency hysterectomy. Methods Total of 110 patients with postpartum hemorrhage in Beijing Shunyi District Hospital from Apr. 2008 to Sep. 2014 were retrospectively analyzed. They were divided into the observation group（ n = 56） that were treated with emergency hysterectomy, and control group （n = 54 ） （without emergency hysterectomy）. The risk factors were screened by comparing the clinical features of the two groups. Results According to the results of single factor analysis the incidence of placental abruption, implanted placenta,placenta previa, uterine fibroids and disseminated intravascular coagulatian （DIC） in the observation group was higher than the control group [ 17.9% （ 10/56 ） vs 1.9% （ 1/54）, 19. 6% （ 11/56 ） vs 3.7 % （2/54） ,35.7% （20/56） vs 11.1% （6/54） ;25.0% （14/56） vs 7.4% （4/54） ] ,the differences were statistically significant （P 〈 0. 05 ）. The results of Logistic multifactor regression analysis showed that emergency hysterectomy was closely related to the factors including placenta previa, placental abruption, placental implantation and DIC （ P 〈 0. 05 ）. Conclusion Emergency hysterectomy is associated with a variety of risk factors, grasping the indications and timing of hysterectomy strictly, and strengthening the perinatal education can reduce the happening of the hysterectomy and improve the quality of delivery.