188例严重产后出血的病因及疾病谱分析

Analysis of Etiology and Disease Spectrum of 188 Cases of Severe Postpartum Hemorrhage

目的分析引起严重产后出血的疾病谱,提高临床对严重产后出血的预防。方法分析188例严重产后出血的原因及其主要的疾病,比较引起严重产后出血主要疾病的输血量及子宫切除率,探索引起严重产后出血的主要疾病的危害性。结果宫缩乏力是产后出血的主要原因,占56.4%,凝血功能障碍及胎盘因素分别为24.5%、16.5%。巨大儿是宫缩乏力的主要原因,占34.0%。输血量超过平均量的严重产后出血的疾病谱中,发生顺位占前5位的是子痫前期-子痫与HELLP综合征(11.7%)、前置胎盘(10.1%)、血液系统疾病(6.4%)、凶险型前置胎盘(4.3%)、胎盘早剥(4.3%)。平均输血量最多的疾病是妊娠期急性脂肪肝(16.5 U)和凶险型前置胎盘(16.3 U)。子宫切除率最高的疾病是产道血肿(40.0%)及凶险型前置胎盘(37.5%)。结论巨大儿是宫缩乏力性严重产后出血的主要原因,临床应做好孕期营养指导,降低巨大儿的发生率;重度子痫前期与HELLP综合征、前置胎盘、血液系统疾病、凶险型前置胎盘、胎盘早剥是引起严重产后出血的最主要疾病,妊娠期急性脂肪肝及凶险型前置胎盘最为凶险,围产期应提高警惕并做好预防措施。

Objective To analyze the disease spectrum that causes severe postpartum hemorrhage, improve the clinical prevention of severe postpartum hemorrhage. Method To analyze the reason and main diseases of 188 cases of severe postpartum hemorrhage, compare the amount of bleeding and hysterectomy rate of diseases that can cause severe postpartum hemorrhage, and explore the harmful- ness of the diseases. Result Uterine inertia is the main reason of postpartum hemorrhage, accounting for 56.4%, coagulatin disorders, 24.5%, placental factors, 16.5%. Giant baby is the main reason of uterine inertia, accounting for 34.0%. In the disease spectrum of se- vere postpartum hemorrhage, preeclampsia eclampsia and HELLP syndrome （11.7%）, placenta praevia （10.1%）, disease of blood system （6.4%）, pernicious placenta previa （4.3%）, and placental abruption （4.3%） have high probability of occurence. Diseases with the most blood transfusion are acute fatty liver of pregnancy （16.5U） and pernicious placenta previa （16.3U）. Diseases with the highest hys- terectomy rate are hematoma of birth canal （40.0%） and pernicious placenta previa （37.5%）. Conclusion Giant baby is the main reason for uterine atony postpartum hemorrhage, good preparations should be made to reduce the occurence rate of giant baby. Severe pre- eclampsia eclampsia and HELLP syndrome, placenta praevia, disease of blood system, pernicious placenta previa, and placental abrup- tion are main diseases that can cause severe postpartum hemorrhage. Acute fatty liver of pregnancy and pernicious placenta previa are very dangerous, precautions should be taken during the perinatal period.