难产性产后出血高危因素及紧急子宫切除术的疗效观察

High risk factors of postpartum hemorrhage due to dystocia and clinical effect of emergency hysterectomy for patients with dystocia

目的研究难产性产后出血的高危因素,探讨紧急子宫切除术对难产性产后出血的临床疗效。方法选取我院产科2014年8月~2015年10月期间收治的分娩产妇192例,其中出现难产性产后出血的68例产妇为观察组,另非难产性产后出血的124例产妇为对照组,比较两组患者一般资料,采用Logistic回归方程分析难产性产后出血的高危因素。将观察组按随机数字表法分为两组,每组各34例,其中34例患者采用宫腔纱布填塞法进行治疗作为观察1组;另34例患者采用紧急子宫切除术治疗作为观察两组,观察紧急子宫切除对难产性产后出血的临床疗效。结果对照组、观察组两组患者在年龄、宫缩乏力、胎盘植入、软产道损伤、前置胎盘、凝血功能障碍、妊娠合并症以及新生儿畸形比较,差异有统计学意义(P<0.05)。将上述有差异项目带入Logistic回归方程计算发现,年龄、宫缩乏力、胎盘植入、软产道损伤、前置胎盘、凝血功能障碍、妊娠合并症以及新生儿畸形均是产妇难产性产后出血的高危因素。观察1组、观察2组治疗总有效率分别为100.00%、79.41%,观察两组总有效率明显较高,两组比较差异有统计学意义(P<0.05)。结论产妇难产性产后出血的高危因素较多,根据产妇分娩前不同症状及特征,针对性实施干预措施,可有效避免产妇发生难产性产后出血。若产妇发生难产性产后出血,经产妇及家属同意后,及时进行子宫切除术治疗,效果良好,对产妇预后具有重要意义。

Objective To study the high risk factors of postpartum hemorrhage due to dystocia and clinical effect of emergency hysterectomy for patients with dystocia. Methods 192 puerperas delivered from August 2014 to October 2015 in our obstetrical department were selected.68 dystocia patients complicated with postpartum hemorrhage were selected as observation group;and 124 patients with postpartum hemorrhage were selected as control group：Through the Logistic regression equation,the high risk factors of postpartum hemorrhage for dystocia patients were analyzed. According to random digital talble method,the patients in observation group were randomly divided into two groups,34 cases in each group.Patients in group one were given the guaze packing in the uterine cavity;and patients in group 2 were given the emergency hysterectomy.The clinical effect was observed. Results The age,uterine inertia,placenta implantation,injury of soft birth canal,placenta previa,coagulation disorder,complications and birth defects for two groups were significantly different（P 〈 0.05）.According to the Logistic regression analysis,the high risk factors of postpartum hemorrhage included age,uterine inertia,placenta implantation,injury of soft birth canal,placenta previa,coagulation disorder, complications and birth defects.The total effective rate of group one（100.00%） was higher than that of group two（79.41%）（P 〈 0.05）. Conclusion There are many high risk factors of postpartum hemorrhage for patients with dystocia.According to the patient＇s symptoms and characteristics,the corresponding interventions can efficiently avoid the occurrence of postpartum hemorrhage.If necessary,it needs to properly take the hysterectomy with the agreement of the puerpera and the family.It is of great importance for the patient＇s prognosis.