产后出血危险因素及凝血功能和纤溶功能指标变化

Risk Factors of Postpartum Hemorrhage and Changes of Coagulation Function and Fibrinolytic Function

目的:探讨产后出血危险因素及凝血功能和纤溶功能指标变化。方法:选取2016年1月-2018年9月笔者所在医院2841例产妇作为研究对象。分析影响产后出血危险因素;采集产妇外周静脉血,分离血浆,测定凝血功能及纤溶功能指标水平。结果:2841例产妇中产后出血76例,产后出血率为2.68%。产后出血产妇年龄≥34岁、剖宫产、宫缩乏力、胎盘早剥、软产道损伤、妊娠期高血压疾病、前置胎盘比例均高于产后正常产妇,差异均有统计学意义(P<0.05)。多因素Logistic回归分析,剖宫产、宫缩乏力和前置胎盘均为影响产后出血独立危险因素。产后出血产妇PT、APTT和D-D均高于产后正常产妇,FIB低于产后正常产妇,差异均有统计学意义(P<0.05)。结论:剖宫产、宫缩乏力和前置胎盘均为影响产后出血独立危险因素,产后及时监测凝血功能指标和纤溶功能指标能够有效降低产后出血率,具有重要临床意义。

Objective:To investigate the risk factors of postpartum hemorrhage and changes of coagulation function and fibrinolytic function.Method:A total of 2841 parturients were selected as the research objects from January 2016 to September 2018 in our hospital.The risk factors of postpartum hemorrhage were analyzed,peripheral venous blood of parturients were collected,and plasma were separated,and indexes of fibrinolytic function and coagulation function were measured.Result:There were 76 cases of postpartum hemorrhage in 2841 cases of parturients,the rate of postpartum hemorrhage was 2.68%.The age of parturients with postpartum hemorrhage≥34 years old,cesarean section,uterine atony,placental abruption,soft birth canal injury,gestational hypertension,placenta previa ratio were all higher than those of the postpartum normal parturients.Multiple factor Logistic regression analysis showed that cesarean section,uterine atony and placenta previa were the independent risk factors for postpartum hemorrhage.The PT,APTT and D-D in the parturients with postpartum hemorrhage were higher than those of the postpartum normal parturients,and the FIB was lower than that of the postpartum normal parturients,and the differences were statistically significant(P<0.05).Conclusion:The cesarean section,uterine atony and placenta previa were independent risk factors of postpartum hemorrhage,postpartum timely monitoring changes of coagulation function and fibrinolytic function can effectively reduce the rate of postpartum hemorrhage,which is of great clinical significance.