产后出血高危因素分析及不同宫缩剂的作用效果研究

Analysis of high-risk factors for postpartum hemorrhage and research on effects of different uterotonics

目的探析导致产后出血发生的危险因素,并比较米索前列醇与缩宫素两种宫缩剂预防产后出血的效果。方法选取2013年1月至2015年1月于成都市青白江区人民医院分娩的1 832例产妇作为本次研究的对象,其中91例发生产后出血,分析可能的危险因素;随机抽取同期收治经阴道分娩的126例产妇,并经数字表示法均分为A组(米索前列醇组)与B组(缩宫素组),两组分别使予米索前列醇与缩宫素预防产后出血,对比两组产后出血情况、不良反应等。结果单因素分析结果显示,流产次数≥2次、胎儿体重≥4kg、合并妊娠高血压疾病、前置胎盘和羊水过多均与产后出血有明显的关联(x^2值分别为18.20、5.70、7.84、4.28、10.99,均P<0.05)。Logistic回归模型结果显示,流产次数、合并妊娠高血压疾病和羊水过多是产后出血的高危因素(OR值分别为1.698、1.587、1.684,均P<0.05)。A组和B组术中出血量比较无显著性差异(t=0.842,P>0.05),但B组产后2h内、24h内出血量均显著高于A组(t值分别为14.62、23.76,均P<0.05),而A组患者总不良反应发生率显著高于B组(x^2=4.60,P<0.05)。结论流产次数、合并妊娠高血压疾病,羊水过多为产后出血的高危因素,使用米索前列醇预防产后出血的效果较好,虽然存在不良反应情况较多,但无需处理即可自行消失。

Objective To explore the risk factors for postpartum hemorrhage and to compare the preventive effects of two uterotonics, namely Misoprostol and oxytocin on preventing postpartum hemorrhage. Methods A total of 1 832 cases of puerperas were chosen as research objects. All these puerperas delivered their babies at People＇ s Hospital of Qinghaijiang in Chendu during the period of January 2013 to January 2015. Among them, 91 cases had postpartum hemorrhage, and possible risk factors were explored. Another 126 cases of puerperas who delivered their babies by vagina at the same period were randomly chosen and divided into group A （ Misoprostol group） and group B （oxytocin group） by digital representations to prevent postpartum hemorrhage. Group A and group B received Misoprostol and oxytooin, respectively. Conditions of postpartum hemorrhage and adverse reactions were compared between two groups. Results Univariate analysis showed that factors such as abortion frequency ≥ 2 times, fetal weight ≥4 kg, hypertensive disorders in pregnancy, placenta previa, and polyhydramnios were all apparently involved in triggering postpartum hemorrhage （Xz value was 18.20, 5.70, 7.84, 4.28 and 10.99, respectively, all P 〈 0.05）. Results of Logistic regression model indicated that abortion frequency, hypertensive disorders in pregnancy and polyhydramnios were high-risk factors for postpartum hemorrhage （ OR value was 1. 698, 1. 587 and 1. 684, respectively all P 〈 0.05 ）. There was no significant difference between group A and group B in amount of bleeding during operation （ t = 0. 842, P 〉 0. 842）. However, the amount of postpartum bleeding of puerperas in group B was significantly higher than that of group A within 2h and 24h （ t value was 14.62 and 23.76, respectively, both P 〈 0.05 ）. Besides, incidence of adverse reaction in group A was significantly higher than that of group B （χ^2= 4.60,P 〈 0.05）. Conclusion Times of abortion, hypertensive disorders in pregnancy and polyhydramnios are high risk factors of postpartum hemorrhage. Misoprostol has achieved relatively good effects on preventing postpartum hemorrhage. Although Misoprostol may cause many adverse reactions, those reactions die away on their own.